Can placenta previa with the umbilical cord wrapped around the neck one time be delivered vaginally?

Written by Zhang Lu
Obstetrics
Updated on November 23, 2024
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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.

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Written by Zhang Lu
Obstetrics
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Is it dangerous for the umbilical cord to be wrapped around the neck during the mid-stage of pregnancy?

During a mid-pregnancy ultrasound, it is sometimes indicated by the presence of a U-shaped or W-shaped notch behind the fetus's neck that the fetus may have the umbilical cord wrapped around its neck. During pregnancy, it is perfectly normal for the umbilical cord to wrap around the neck, and it generally does not affect the fetus or pose any danger. The length of the umbilical cord during pregnancy is approximately 30 to 80 centimeters, which is quite long relative to the size of the uterine cavity. Hence, many umbilical cords have excess length that can wrap around the neck or limbs of the fetus, leading to the umbilical cord being coiled around the neck or limbs. However, current research indicates that whether the umbilical cord is wrapped around the neck or limbs once or twice, it does not affect the fetus. It does not cause intrauterine hypoxia or affect the growth and development of the fetus, nor does it influence the mode of delivery. A natural childbirth can still be an entirely viable option.

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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 Du Rui Xia
Obstetrics
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What will the fetal movement be like if the umbilical cord is wrapped around the neck?

Generally, when the umbilical cord is wrapped around the neck, it often does not affect the fetal movement or fetal heart rate changes. It is quite common for the cord to be wrapped around once, and if the wrapping is loose and does not affect the blood supply from the placenta, fetal movement will not change. However, if the cord is tightly wrapped multiple times, it can affect the blood supply of the umbilical cord and impact the fetal blood circulation, leading to frequent fetal movements. Therefore, pregnant women should learn to count fetal movements themselves to understand if the fetus is experiencing hypoxia in the womb.

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Written by Du Rui Xia
Obstetrics
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How to count fetal movements when the umbilical cord is wrapped around the neck

When there is nuchal cord presence, it is important to determine the number of loops around the neck as well as the tightness of the loops, to assess if they might affect the fetal heart rate. Generally, nuchal cords do not impact fetal blood circulation, so fetal movement can still be measured normally. Proper measurement should be taken at fixed times each day: morning, noon, and evening—for example, at 7 AM, 12 PM, and 9 PM respectively. During each of these times, select one hour when you can calmly and attentively feel and count the baby’s movements in a quiet setting, and record the number of movements.

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Written by Zhang Lu
Obstetrics
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Can you have a vaginal birth if the umbilical cord is wrapped around the neck once?

Umbilical cord wrapping is a common physiological phenomenon during pregnancy, mainly because the length of the umbilical cord during pregnancy generally ranges from 30cm to 80cm, which far exceeds the length needed for fetal growth and development. Therefore, occurrences like the umbilical cord wrapping around the neck or limbs are quite normal. An umbilical cord around the neck is not an indication for cesarean section, and a vaginal delivery is entirely feasible, even if the cord wraps around the neck once or even twice. However, due to the special circumstance of the umbilical cord being wrapped around the neck, it is crucial to pay attention during the delivery process. First, it is important to monitor the fetal heart rate closely, as umbilical cord wrapping can lead to fetal hypoxia, which would be indicated by changes in the fetal heart rate. Second, preparations for an emergency cesarean section should be in place in case of an abnormal fetal heart rate, at which point a cesarean may be necessary to terminate the pregnancy.