Nuchal Cord

What is a nuchal cord?

A nuchal cord happens when the umbilical cord is completely wrapped around your baby’s neck during delivery. “Nuchal” means “neck.” It can happen during pregnancy as well.

The umbilical cord is a flexible, tubelike structure that connects the fetus to the placenta. It transfers oxygen, blood and nutrients from the mother’s body to the fetus.

It can be scary to hear that your baby’s umbilical cord is wrapped around their neck. But know that nuchal cords almost never cause complications during or after birth. Your pregnancy care provider can explain this finding.

Types of nuchal cords

Healthcare providers use the following terms to describe nuchal cords:

• Single nuchal cord: There’s one loop of the umbilical cord around your baby’s neck
• Multiple nuchal cords: There’s more than one loop of the umbilical cord around your baby’s neck

Providers may also describe the nuchal cord as “loose” or “tight”:

• A loose nuchal cord may come undone by fetal movement during pregnancy.
• Loose nuchal cords are more common than tight nuchal cords.
• Tight nuchal cords are more likely to cause complications than loose nuchal cords.

What percentage of babies are born with a nuchal cord?

Up to 25% of babies (1 in 4) are born with a single nuchal cord, so it’s fairly common. About 2.4% to 8.3% of babies (2 to 8 out of 100 babies) are born with two or more loops (multiple nuchal cords).

What are the signs of a nuchal cord?

During pregnancy and labor, one possible sign of a nuchal cord is variable decelerations in fetal heart rate monitoring. This means the fetus’s heart rate temporarily drops below a healthy rate.

Variable decelerations usually mean there’s a blockage of blood flow through the umbilical cord. Or it could mean there’s a compression (squeezing) of the vessels within the cord. A nuchal cord could cause this. But other situations can as well, like a knot in the cord or umbilical cord prolapse.

If there are fetal heart rate decelerations, your care team will act quickly to keep you and the fetus safe.

What causes a nuchal cord?

Nuchal cords happen randomly. The biggest risk factors include:

• Excessive fetal movement
• A long umbilical cord (over 27 inches long)
• Large amounts of amniotic fluid (polyhydramnios)

There’s nothing you can do to manage these risk factors. It’s not your fault if your baby has a nuchal cord when they’re born.

What are the complications of a nuchal cord?

Loose nuchal cords very rarely cause issues. Your pregnancy care provider can usually slip the loop over your baby’s head when it comes through the birth canal.

Infants with a tight nuchal cord may — but not always — develop any of the following complications after birth:

• Broken blood vessel in their eye (subconjunctival hemorrhage)
• Low blood pressure (hypotension)
• Low blood volume (hypovolemia)
• Mild breathing issues (respiratory distress)
• Pinpoint-sized spots of bleeding under the skin on their face (facial petechiae)
• Skin abrasions around their neck
• Temporary face discoloration

These complications typically aren’t severe and usually don’t cause lasting health issues.

In very rare cases, a tight nuchal cord can cause:

• Significant blood loss
• Acidosis (acidic blood)
• Anemia

Your baby’s healthcare team will know how to manage these complications if they happen.

How is a nuchal cord diagnosed?

During pregnancy, your healthcare provider may see a nuchal cord during an ultrasound. But they may not report the finding. This is because nuchal cords are common and typically considered normal. As long as blood is flowing properly through the umbilical cord, there usually isn’t a concern. Your provider can check blood flow with Doppler ultrasound.

Before delivery, your pregnancy care provider may check for a nuchal cord with a physical test. It involves applying pressure to the fetal neck area through your abdomen (belly). If the pressure results in a drop in fetal heart rate, it means there’s a risk of umbilical cord compression. Your provider will closely keep track of the fetal heart rate monitoring so they can act quickly if it points to complications.

How is a nuchal cord managed during labor and delivery?

There’s no way to undo or fix a nuchal cord during labor. Healthcare providers look for signs of umbilical cord issues with fetal heart rate monitoring during labor and delivery. If there are drops in fetal heart rate, your care team will manage it. This usually involves:

• Changing how you’re positioned (like turning from one side to the other)
• IV fluids
• Oxygen therapy

During delivery, your pregnancy care provider will feel for the umbilical cord around your baby’s neck once their head is through the birth canal. If there’s a loose nuchal cord, they can usually slip it over your baby’s head.

If the nuchal cord is too tight, your provider may be able to use the somersault maneuver to deliver your baby. They position your baby in a way that keeps their head close to your pelvis. This allows the cord to not pull as much on your baby’s neck as the rest of their body passes through the birth canal.

Can a baby with a nuchal cord be delivered normally?

In most cases, nuchal cords don’t complicate delivery. This means you can deliver your baby as planned.

In rare cases, a tight nuchal cord may block blood supply through the umbilical cord, causing fetal distress. If this happens, you may need an emergency C-section.

If the fetus is in breech position and has a nuchal cord, your healthcare provider will likely not recommend doing external cephalic version (ECV) or vaginal delivery. You’ll likely need a C-section.

How can I prevent an umbilical cord around the neck?

There’s nothing you can do to prevent a nuchal cord. You can’t control how the fetus and umbilical cord move in your uterus. And you can’t do anything to unwind the cord. Your healthcare team will know what to do if they discover a nuchal cord during the delivery of your baby.

Should I be worried about a nuchal cord?

In the vast majority of cases, nuchal cords aren’t a concern. They’re not linked to stillbirth or serious health issues. Your pregnancy care provider will know how to manage a nuchal cord. They’ll tell you if it may be causing complications like fetal distress.