Umbilical Cord Compression: the signs, the risks and my experience of representing children suffering from undiagnosed cord compression

October 29, 2018

Posted by: Mala Patel


Pregnancy is an exciting time for parents-to-be but there can be risks and complications when the baby is in the womb.  This blog focuses on the specific risk of umbilical cord compression within the womb and the effect this can have on the baby.

The umbilical cord

The umbilical cord is a flexible cord-like structure which connects a baby in the womb to its mother during pregnancy.  The cord runs from an opening in the baby’s stomach to the placenta which is attached to the wall of the mother’s uterus.  The average umbilical cord is 50cm long[1] and it is made up of one vein and two arteries.  The vein carries blood rich in nutrients and oxygen from the mother to the baby.  The arteries carry deoxygenated blood and waste products from the baby back to the mother via the placenta[2].

What is umbilical cord compression?

Umbilical cord compression is a medical term used to describe a condition in which a baby’s umbilical cord becomes flattened by pressure, resulting occasionally in heightened and extremely dangerous health risks for the unborn baby[3].

During pregnancy, many babies will experience very mild compressions as a result of their movement within the womb and these are often harmless.

It is when the umbilical cord is compressed more severely or for a longer period of time that the blood and oxygen supply to the baby can become significantly impaired.  Unless this problem is resolved quickly, the baby can suffer from asphyxiation, brain damage and even death.

Risk factors for umbilical cord compression

Whilst umbilical cord compression is a largely unpredictable event, there are certain risk factors which can alert doctors to the increased risk of this occurring:

  • Abnormal levels of amniotic fluid:  When there is too little amniotic fluid (also known as oligohydramnios), this can increase the risk of the cord becoming compressed between the baby and the wall of the uterus.  Equally, where there is too much amniotic fluid (polyhydramnios), this can also increase the risk of cord compression because it can cause premature rupture of the membranes which in turn can cause an umbilical cord prolapse (see below)[4].
  • Umbilical cord prolapse:  In a typical birth, the baby’s head will descend into the birth canal first followed by the rest of the body and the umbilical cord[5].  Umbilical cord prolapse is where the umbilical cord slips through the birth canal either before or alongside the baby’s body.  This can cause the umbilical cord to become compressed.  This specific problem is more common where the birth involves the premature rupture of membranes which is where the ‘waters break’ before the labour begins. 
  • Abnormally long umbilical cord:  If the umbilical cord is longer than normal, this can increase the chance of a ‘true knot’ developing and in turn causing cord compression.  A true knot is where the umbilical cord becomes tied in a knot.  Typically, a knot in the umbilical cord is not problematic as the cord is made of a spongy material which prevents the knot from becoming too tight.  However, as the baby moves around the womb, there is a risk that the knot will become tighter and this could cause cord compression.
  • Nuchal cord:  This is a complication where the umbilical cord becomes wrapped around the baby’s neck.  Nuchal cords are fairly common and typically do not affect the safe delivery of the baby.  However, sometimes the cord can tighten around the baby’s neck preventing blood and oxygen flow to the baby and a decrease in the baby’s heart rate[6].

Signs of umbilical cord compression

It is not always easy to detect umbilical cord compression whilst the baby is within the womb.  However, there are certain clues which help to indicate the occurrence of cord compression:

  • Reduced fetal movement:  Pregnant women may be able to notice a difference in the baby’s movements after umbilical cord compression and the baby’s movements may become less frequent[7]. 
  • Change in heart rate:  A drop in the baby’s heart rate is one of the first recognisable signs of umbilical cord compression.  Fetal heart monitoring is required to detect this and alarm is often raised when the baby’s heart beat declines to less than 100 beats per minute[8]. 
  • Dropping of the umbilical cord:  Where there is an umbilical cord prolapse, the mother may be able to physically feel the umbilical cord dropping into the birth canal when her waters break. 
  • Intrauterine growth restriction:  If the umbilical cord has been compressed for a long period of time, this can prevent the baby from getting enough nutrition to grow at a normal rate[9]. 

Management of umbilical cord compression

The treatment of umbilical cord compression depends upon the underlying cause of the compression, the health of the baby and the likelihood of the baby’s condition deteriorating.  Management options include:

  • Amnioinfusion:  If the level of amniotic fluid is low then saline solution can be introduced into the mother’s uterus to relieve the pressure that can lead to umbilical cord compression[10]. 
  • Delivery by caesarean section:  If the baby is showing serious signs of distress such as a deceleration in the heart rate then an emergency caesarean section may be needed. 

Injuries caused by umbilical cord compression and prognosis 

If the umbilical cord compression is detected and managed within an appropriate time then the baby can often be delivered without any lasting impact on them.

However, if there is a failure to detect and /or treat the umbilical cord compression promptly then this can cause serious and lasting harm to the child including the following:

  • Behavioural disorders
  • Intrauterine growth restriction
  • Cerebral palsy
  • Autism
  • Fetal death

‘Katie’s’ case

In my line of work, it is unfortunately not uncommon to have cases of umbilical cord compression where there has been a failure to detect and/or appropriately treat fetal distress which in turn results in the baby sustaining brain damage. 

I have previously acted for a little girl, who I will refer to as ‘Katie’, in a case involving umbilical cord compression.  Katie’s mother had a normal pregnancy although prior to Katie’s delivery, the doctors identified a drop in Katie’s heart rate.  There was a failure to identify the need for an emergency caesarean section and therefore a delay in Katie’s delivery.  Katie was eventually delivered by emergency caesarean section with her umbilical cord wrapped tightly around her neck.  She suffered from a prolonged period of reduced oxygen and was later diagnosed with cerebral palsy.

The expert evidence in Katie’s case indicated that she should have been delivered earlier by emergency caesarean section in light of her dipping heart rate.  Whilst Katie was able to tolerate a short period of time with a reduced oxygen supply without sustaining brain damage, it was the prolonged deprivation of oxygen which caused her to suffer from irreversible brain damage.

Katie now has life-long needs as a result of her cerebral palsy. 

Where a child has sustained a brain injury as a result of umbilical cord compression, they will often require long term specialised care and rehabilitation which can include medication, therapies, educational support and adaptations to their home.

The long term effects of a brain injury caused by umbilical cord compression on a child and their family can be both financially and emotionally taxing.  Many of our clients and their families have found that our specialist legal advice and support has really made a difference in helping the injured child thrive.

Claiming compensation for your brain injured baby

In the Child Brain Injury department, we act exclusively for children who have suffered brain injuries as a result of negligence.  We are experts in this field and are dedicated to supporting brain injured children and their families not only with their compensation claims but also with the ancillary support they need to flourish and achieve their potential.

Mala Patel is a senior solicitor in the Child Brain Injury team at Bolt Burdon Kemp.  If you would like advice about making a claim on behalf of a brain-injured child, contact Mala free of charge and in confidence on 020 7288 4822 or at malapatel@boltburdonkemp.co.uk.  Alternatively, complete this form and one of the solicitors in the Child Brain Injury team will contact you.  Find out more about the Child Brain Injury team.

 

[1] https://www.nhs.uk/common-health-questions/pregnancy/what-is-the-umbilical-cord/

[2]https://www.nhs.uk/common-health-questions/pregnancy/what-is-the-umbilical-cord/

[3] https://www.birthinjuryguide.org/birth-injury/causes/umbilical-cord-compression/

[4] https://www.abclawcenters.com/umbilical-cord-compression/

[5] https://www.abclawcenters.com/umbilical-cord-compression/

[6] https://www.abclawcenters.com/umbilical-cord-compression/

[7] https://www.birthinjuryguide.org/birth-injury/causes/umbilical-cord-compression

[8] https://www.birthinjuryguide.org/birth-injury/causes/umbilical-cord-compression/

[9] https://www.abclawcenters.com/umbilical-cord-compression/

[10] https://www.abclawcenters.com/umbilical-cord-compression/

Posted by: Mala Patel

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