Understanding Umbilical Cord Birth Injuries

The umbilical cord carries oxygen and nutrients from the placenta to your baby throughout pregnancy and labor. This page explains how cord compression and related complications can affect a baby, how clinicians may respond, and when the care provided may warrant closer review.

What are umbilical cord birth injuries?

The umbilical cord connects the baby to the placenta and contains blood vessels protected by a soft substance called Wharton’s jelly. These vessels deliver oxygenated blood and nutrients to the baby and carry waste products back toward the placenta.

Umbilical cord birth injury is a broad term for harm associated with pressure on the cord, displacement of the cord, a tight loop or entanglement, a true knot, or another condition that interferes with blood flow. Cord compression may be brief and harmless, or it may become recurrent or severe enough to create concerning fetal heart rate changes.

Not every umbilical cord finding causes an injury. Many nuchal cords, in which the cord is wrapped around the baby’s neck, are loose and do not affect the baby. The risk depends on the type of complication, how much blood flow is restricted, how long it lasts, and how the baby responds. A prolonged or severe interruption can contribute to fetal acidemia, hypoxic-ischemic encephalopathy, or injury to other organs.

Signs of an umbilical cord complication

Many umbilical cord conditions cause no symptoms that a parent can feel, and some are not discovered until labor or delivery. Warning signs may appear through changes in fetal movement, fetal heart rate monitoring, a vaginal examination, or the baby’s condition after birth.

Signs that may require prompt assessment include:

• A noticeable decrease or change in the baby’s usual movement pattern before labor
• Recurrent variable decelerations, which are abrupt drops in the fetal heart rate often associated with cord compression
• A prolonged fetal heart rate deceleration or persistent bradycardia, especially soon after the membranes rupture
• A fetal heart rate pattern that does not recover or continues to worsen despite initial corrective measures
• An umbilical cord that is felt or seen in the vagina after the water breaks, which may indicate cord prolapse
• Poor muscle tone, weak or absent breathing, a low heart rate, or the need for substantial resuscitation after birth
• Seizures, abnormal alertness, feeding difficulty, or other neurologic concerns during the newborn period
• Cord strangulation may be suspected if there is a significant decrease or absence of fetal movement, especially after 28 weeks of pregnancy.

An isolated heart rate change does not necessarily mean that a baby has been injured. Clinicians evaluate the full tracing, the timing of the changes, the stage of labor, membrane status, maternal condition, and the baby’s response to determine whether additional intervention is needed.

What causes umbilical cord injury?

Umbilical cord complications can develop before labor, occur when the membranes rupture, or become significant as contractions and fetal descent place pressure on the cord. Many are unpredictable and are not caused by anything a parent did during pregnancy.

Circumstances that can cause or increase the risk of cord compression include:

• Pressure on the cord between the baby and the wall of the uterus or birth canal during contractions
• A tight nuchal cord or another cord loop around the baby’s neck or body
• Cord prolapse, in which the cord descends alongside or beyond the presenting part after the membranes rupture
• A true knot that tightens and restricts blood flow through the cord
• Low amniotic fluid, which provides less cushioning around the cord
• A breech, transverse, or unstable fetal position or a presenting part that remains high or unengaged
• Prematurity, multiple pregnancy, or excess amniotic fluid, which may increase the likelihood of cord prolapse
• Artificial rupture of the membranes or another obstetric procedure performed when the presenting part is high or mobile

Some risk factors can be recognized before or during labor, while others cannot be reliably predicted. Their presence may affect delivery planning, the timing and method of membrane rupture, and the level of fetal monitoring used.

When an umbilical cord birth injury may be medical malpractice

Not every umbilical cord complication or birth injury is medical malpractice. Cord problems can arise suddenly and may cause no harm when care is appropriate. However, the following circumstances may point to negligence when a failure to monitor, diagnose, or respond contributes to an avoidable injury:

• Failing to use appropriate fetal heart rate monitoring during labor or after a clinically significant change or procedure
• Failing to recognize recurrent variable decelerations, a prolonged deceleration, persistent bradycardia, or another pattern that may indicate cord compression
• Failing to promptly evaluate for cord prolapse when an abnormal fetal heart rate begins after spontaneous or artificial rupture of the membranes
• Artificially rupturing the membranes when the presenting part is high or mobile without assessing the risk of prolapse or preparing for an emergency delivery
• Failing to reduce pressure on a prolapsed cord or take other immediate measures while preparing for birth
• Continuing uterine-stimulating medication or failing to address excessive uterine activity when the fetal heart rate tracing is concerning
• Failing to escalate care or delaying cesarean or operative delivery despite persistent fetal heart rate abnormalities or a diagnosed cord emergency
• Failing to have appropriate neonatal resuscitation support available after a cord emergency
• Failing to promptly evaluate a newborn for hypoxic-ischemic encephalopathy or other complications after signs of oxygen deprivation

Wais, Vogelstein, Forman, Koch & Norman, LLC works with qualified obstetric, maternal-fetal medicine, fetal monitoring, neonatal, neurology, and other medical experts to review prenatal imaging, labor records, fetal heart rate tracings, delivery timing, cord blood results, newborn care, and follow-up records to determine whether accepted standards were followed.

Treatment and long-term outlook

Treatment depends on the type of cord complication, the fetal heart rate pattern, the stage of labor, and whether the baby shows signs of reduced oxygen delivery. Some cord findings can be seen on ultrasound, but many cannot be reliably diagnosed before labor and are recognized through fetal monitoring or examination.

When cord compression is suspected during labor, the medical team may change the patient’s position, evaluate for prolapse, reduce uterine stimulation, address excessive contractions, and reassess the fetal heart rate. If a cord prolapse is diagnosed, clinicians may elevate the presenting part and use maternal positioning to reduce pressure while preparing for immediate birth. Cesarean delivery is generally recommended when a safe vaginal birth is not imminent.

After delivery, a baby who shows signs of oxygen deprivation may need resuscitation, cord blood gas testing, neurologic assessment, and care in a neonatal intensive care unit. A newborn with signs of moderate or severe hypoxic-ischemic encephalopathy may need a time-sensitive evaluation for therapeutic hypothermia and other supportive treatment.

Many babies have no lasting effects when a cord complication is brief and promptly corrected. The outlook can be more serious when blood flow is severely restricted or the response is delayed. Possible outcomes may include hypoxic-ischemic encephalopathy, seizures, cerebral palsy, developmental or learning challenges, organ injury, or infant death. Follow-up with pediatric, neurologic, developmental, and therapy specialists may help identify and address a child’s needs over time.