Cord around the neck syndrome: What parents should know

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What happens when the umbilical cord wraps around baby's neck in pregnancy?

During pregnancy, the umbilical cord connects you and your baby. As the conduit through which nutrition and oxygen are passed to your baby, there’s no doubt that it is a life giver. Except in one instance where it may pose a health risk — when it wraps around your developing baby’s neck. This is known as nuchal cord, or cord around the neck (CAN) syndrome. What exactly is this condition? And what are cord around the neck symptoms you should know? 

cord around the neck symptoms

Are you aware of cord around the neck symptoms? Image credit: Nuchal Cord Complication Art Print by Medi-mation/ Science Photo Library

What is cord around the neck syndrome? 

First things first, mums-to-be. We know you’re probably worried right now about the possibility of your baby being “strangled” by his own umbilical cord. But stop fretting right now.

A normal and healthy umbilical cord is protected against getting tangled up, and wrapped around your baby’s neck. This is because it is filled with a soft, slippery substance known as Wharton’s Jelly

Wharton’s Jelly protects the blood vessels inside the cord. It also helps prevent cord compression and tight knots. Even if knots form, this jelly-like substance usually stops them from tightening. 

In fact, it’s fairly normal for the umbilical cord to tangle, twist and knot around the baby’s body in many pregnancies. Sometimes though, the umbilical cord wraps around the baby’s neck during pregnancy or birth. It is this knot that is known as a nuchal cord

According to an article published in BMC Pregnancy Childbirth, a nuchal cord (or Cord-Around-the Neck (CAN)) occurs when the umbilical cord becomes wrapped around the fetal neck 360 degrees.”

According to medical experts, nuchal cords are quite common, occurring in around one in three births. And, unless there is a serious complication related to the umbilical cord, babies born with nuchal cords are healthy. 

cord around the neck symptoms

Carrying twins or multiples can increase the chances of nuchal cord, like in this image of twins’ knotted umbilical cords. Image credit: Monoamniotic stories blogspot.

Causes of cord around the neck

When you think about just how much little ones move around in the womb, it’s not surprising that the umbilical cord gets tangled and twisted. 

However, other than your baby’s supreme gymnastic abilities, there are other reasons for nuchal cords to occur. 

  • Having twins or multiples: If one in three singleton births have nuchal cords, then just imagine that doubled! With the movement of two or more babies in the womb, needless to say, the chances of nuchal cord occurring is higher. 
  • Not enough Wharton’s Jelly: As explained previously, Wharton’s Jelly keeps the umbilical cord well lubricated, minimising the risk of knotting. When there is not enough of this substance, nuchal cord may occur. 
  • Length of umbilical cord: The average umbilical cord length is 50-60 centimetres long. Medical researchers suggest that when the umbilical cord is longer, the chances of nuchal cord occurring are higher. As reported in one study, “the long[er] umbilical cords seemed to be associated with the increased rate of multiple nuchal cords and true umbilical knots.”

Cord around the neck symptoms

There are a few cord around the neck symptoms that might indicate the presence of nuchal cord. 

  • Reduced baby movement: If much less movement is recorded after 37 weeks gestation, this could be one of the cord around the neck symptoms. A baby at this stage of pregnancy should be kicking around five times every 30 minutes. 
  • Abnormal heart rate: During labour, a baby’s heart rate is monitored consistently. If there are any abnormalities in the heart rate, it could indicate nuchal cord. 
  • Baby suddenly moves forcefully and then, less: According to a BMC Pregnancy and Childbirth article, this sudden hyperactivity followed closely by a lull in movement could indicate baby is trying to reposition himself to relieve the pressure caused by the nuchal cord. 
  • An ultrasound shows it: More often than not, an ultrasound won’t reveal a nuchal cord. However, around 70 percent of the time, your doctor will detect it (if present) during a regular pregnancy scan. 

Nuchal cord complications

We stress again — nuchal cords are more common than you think and usually result in absolutely no problem for baby. However sometimes, complications may occur. These are more likely if the umbilical cord is wrapped very tightly and several times around baby’s neck. 

The worst-case scenario is when the cord is wrapped very tightly around the body, cutting off blood flow in umbilical veins. According to the Stillbirth Collaborative Research Network, around 10 percent of stillbirths are caused by such cord accidents.

Managing a nuchal cord

If a nuchal cord is detected during a scan, unfortunately there isn’t much doctors can do to correct it. During labour, if a nuchal cord is suspected (indicated by abnormal heart rate in baby, for example), the doctors will try to manage it until baby is born. They might increase oxygen to the mother, or roll her over to reduce compression and pressure. 

If baby’s heart rate really drops, then an emergency C-section might be conducted. Sometimes when a nuchal cord is suspected and the mother is close to birthing her baby, the doctor may inject fluid into the uterus (amnioinfusion) which may help relieve some of the pressure. 

When baby’s head crowns and if the doctor notices the most obvious of all cord around the neck symptoms — which is literally the cord wrapped around the neck — then they will just slip the loop of cord off once the head is out. 

If the cord is wrapped too tightly around baby’s neck, the doctor might clamp and cut the cord before baby is fully delivered. 

Mums-to-be, ultimately, do remember that you shouldn’t panic about nuchal cord and cord wrapped around the neck symptoms. But as with everything pregnancy and parenting related, it’s good to be aware and educated about such conditions so you know what to do. 

Also read: The function of the umbilical cord

Reference: BMC Pregnancy Childbirth

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