Does an umbilical cord around the neck always require a cesarean section?

Written by Du Rui Xia
Obstetrics
Updated on September 12, 2024
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When nuchal cord occurs, it is not always necessary to perform a cesarean section, because sometimes the cord may be loosely wrapped around, even if only for one loop, and in such cases, natural childbirth is still possible. However, if the nuchal cord is wrapped more than two or three times, and is tightly wrapped, and if there is fetal hypoxia inside the uterus, then a cesarean section must be performed to quickly terminate the pregnancy. Nuchal cord is a common cause of difficult labor in pregnant women. Therefore, during the later stages of pregnancy, regular prenatal check-ups should be carried out to monitor the fetus's health. If any abnormalities are detected, it is urgent to admit to the hospital for delivery to avoid potential impacts on the baby, such as hypoxia or asphyxiation.

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Written by Zhang Yin Xing
Obstetrics
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What should I do if the umbilical cord is wrapped around the neck once?

Umbilical cord wrapping around the neck once is a very common phenomenon, occurring in 20% of fetuses. When the umbilical cord wraps around the neck once, if the umbilical blood flow and fetal movements are normal, it indicates that the cord wrapping does not affect the fetus and will not have a direct impact on the fetus's intrauterine growth and development. However, during childbirth, attention must be paid to the possibility that the umbilical cord wrapping may cause difficulties in the descent of the presenting part of the fetus, leading to abnormal umbilical blood flow. If difficulties in the descent of the presenting part and changes in the fetal heart rate occur during delivery, the possibility of umbilical cord wrapping should be considered. If necessary, a cesarean section should be performed to terminate the pregnancy. There are no medications or other treatments that can alleviate umbilical cord wrapping; instead, enhanced prenatal monitoring is sufficient.

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Written by Liu Wen Li
Obstetrics
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What should I do if the umbilical cord is wrapped around the neck once during the mid-pregnancy?

The incidence of the umbilical cord wrapping around the neck once is quite high, accounting for about one-fifth of pregnant women. Generally, if the umbilical cord is loosely wrapped around the child's neck, and if the cord is long enough, it usually does not have a significant impact on the fetus. However, if the umbilical cord is tightly wrapped around the neck, and additionally, if the cord is relatively short, it can sometimes lead to pulling and thinning of the cord, causing obstruction in the blood vessels within the cord. This can result in oxygen deficiency for the baby. Therefore, during the mid-pregnancy period when umbilical cord entanglement occurs, it is important to enhance monitoring. Regular prenatal check-ups, counting fetal movements by oneself, and frequent monitoring of fetal heart rate changes are advisable.

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Written by Zhang Yin Xing
Obstetrics
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Is moxibustion useful for breech presentation and nuchal cord?

Fetal breech presentation and nuchal cord can be effectively addressed with moxibustion. Breech positions are common in early pregnancy but typically resolve to a head-first position by 32 weeks and become relatively stable. Higher incidences of breech positions are noted in cases of fetal abnormalities, twin pregnancies, abnormal amounts of amniotic fluid, uterine abnormalities, and narrow pelvis. If a breech position is still present after 32 weeks, moxibustion treatment can be considered. Moxibustion is applied at the Zhiyin acupoint (located 0.1 inches beside the nail corner on the outer side of the little toe) and is generally recommended once daily for 15 to 30 minutes, with one week constituting a treatment course. Afterward, the improvement in the fetal position can be evaluated. The purpose of using moxibustion is to promote fetal activity, which may help resolve nuchal cord entanglement during fetal movements.

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Written by Zhang Yin Xing
Obstetrics
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How to prevent umbilical cord entanglement in late pregnancy

There are no effective prevention methods for nuchal cord, which is the most common form of umbilical cord entanglement where the cord wraps around the fetus's neck, limbs, or trunk. Nuchal cord occurs in 90% of these cases, frequently involving the cord wrapping around the neck once. This phenomenon can be observed in 20% of deliveries and is associated with factors such as an overly long umbilical cord, a small fetus, excessive amniotic fluid, and frequent fetal movements. An excessively long umbilical cord is mostly a physiological occurrence since the cord floats in the amniotic fluid and its actual length cannot be accurately measured, with no effective methods to prevent its occurrence. Excessive amniotic fluid and a small fetus are linked to certain pregnancy complications, such as diabetes-induced polyhydramnios and restricted fetal growth. Actively controlling blood sugar during pregnancy can prevent such issues. Frequent fetal movements are physiological for some pregnant women. Women who experience more frequent fetal movements throughout pregnancy are likely to encounter nuchal cord. Clinically, nuchal cord does not require special management unless it leads to obstructions in fetal descent, fetal distress, or variations in fetal heart rate. It does not impact delivery or fetal development.

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Written by Zhang Lu
Obstetrics
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Can placenta previa with the umbilical cord wrapped around the neck one time be delivered vaginally?

Placenta previa and umbilical cord around the neck are two relatively common clinical conditions during pregnancy, and they have different impacts on natural childbirth. First, having the umbilical cord wrapped around the neck once is a very normal physiological occurrence, and it generally does not affect the ability to have a natural childbirth in any situation. Therefore, from the perspective of the umbilical cord around the neck, it does not affect natural childbirth. Second, placenta previa refers to the lower edge of the placenta being close to the internal os of the cervix. Whether natural childbirth is possible mainly depends on the type of placenta previa. If it is a partial or central placenta previa, such conditions generally cannot proceed with natural childbirth, as they might cause significant bleeding, necessitating an elective cesarean section. However, in the case of marginal placenta previa, where there is still some distance between the lower edge of the placenta and the cervical os, attempting natural childbirth might be possible, provided that preparations for a cesarean section are in place.