Umbilical Cord Complications
The umbilical cord is the means in which the fetus is connected to the placenta during gestation. During prenatal development this cord is both genetically and physiologically a part of the fetus. The umbilical cord consists of two arteries and one vein buried within a gelatinous substance known as Wharton’s Jelly. The purpose of the umbilical cord is to supply the baby with oxygenated, nutrient-rich blood from the placenta, as well as carry deoxygenated, nutrient-depleted blood out.
Umbilical Cord Abnormalities
Cases of umbilical cord irregularities capable of causing harm include:
- Umbilical Cord Compression
- Velamentous Cord Insertion
- Single Umbilical Artery
- Umbilical Cord Prolapse
- Vasa Praevia
Umbilical cord compression can result from the entanglement of the umbilical cord, a knot in the cord, or a nuchal cord which is when the umbilical cord wraps around the fetal neck. Cord compression can obstruct blood flow through the umbilical cord due to pressure from an external object or misalignment of the cord itself. In the case of nochal cords fetal bradycardia and variable decelerations in fetal heart rate occur almost twice as often as those with normal placed umbilical cords. Nevertheless, nuchal cords are somewhat common and typically resolve themselves; they are rarely associated with significant morbidity or mortality in neonates.
Umbilical cord compression can lead to perinatal asphyxia which is a common cause of birth injury in children. Perinatal asphyxia is a severe lack of oxygen to the fetus during labor and delivery. This condition occurs in 2 to 4 out of every 1,000 live-birth term infants and even more frequently in preterm births. It is estimated that anywhere between 20 and 50 percent of term asphyxiated newborns die during the newborn period, which accounts for 23 percent of neonatal deaths worldwide.
Up to 60% of surviving infants are left with severe neurodevelopmental handicaps, including:
- Mental Retardation
- Cerebral palsy
- Learning Disabilities
Early Vs. Delayed Clamping
Within the medical community there is a debate over the proper time to clamp an umbilical cord and whether or not that specific timing is related to any adverse conditions that may develop. In general, hospital-based obstetric practice calls for artificial clamping in as early as one minute after birth. Birthing centers on the other hand, may delay the practice by five minutes or more or they may omit it altogether.
A 2008 Cochrane Review found that clamping later than 60 seconds after birth showed a statistically higher risk of neonatal jaundice requiring phototherapy. However, in the same year another randomized, controlled trial published in Examination of the Newborn and Neonatal Health compared the timing of cord clamping and reported an increase in anemia in infants whose cords were clamped immediately. It should be noted that medical consensus dictates that delayed clamping is not an adequate solution in cases involving a newborn that is not breathing well needing resuscitation. In fact, a pulsing umbilical cord is not a guarantee that the baby is receiving enough oxygen.