Like the placenta, the umbilical cord is an essential component of pregnancy - your baby's literal lifeline. And also like the placenta, unfortunately there is far less respect given to this crucial pregnancy organ than it's due.
Evidence supports that 20% of all stillbirths are related to umbilical cord pathology. Just over half take place after 32 weeks gestation. Research also indicates that, of the reported 2 million stillbirths worldwide, close to 50% are preventable. Extrapolating on that math, it can be estimated that around 400,000 stillbirths are related to umbilical cords, and of that, potentially 200,000 could be prevented.
The good news is that umbilical cords can be imaged using existing ultrasound color doppler technology. From there, most conditions that appear can be safely managed, and affected babies delivered safely. So, what's the problem? Why are so many babies lost to cord incidents or "accidents," to which they are so casually referred?
Even though the cord can be imaged, there are no standards of care when it comes to cord management. Although there are some reports that are suggesting a change, currently there are no recommendations to review the umbilical cord for abnormalities by obstetrical organizations. Pregnant people need to request a full cord scan at 20 weeks and beyond, and most practitioners will deny this request. If they do, the advice of cord specialists is to go to a boutique ultrasound and have it done there.
What can be imaged? The following aspects of the cord can be clearly seen (yet, only the first two are commonly checked):
Cord insertion: where the cord inserts into the placenta is very important and rarely discussed. Velementous insertion is when the cord inserts into fetal membranes and not the placenta.
Artery formation: the umbilical cord should have two arteries and one vein.
Tangled, coiled, or twisted cords, and where they are impacted. This can lead to diagnosis of true knots before they happen, by diagnosing if a loop is a wrap or hitch type, and seeing if a cord is hyper- or hypo-coiled. True knots can cause stillbirth and other complications. More on knots here.
Cord length, and if it is average, shorter, or longer. Length and place of placenta can impact delivery and tangles. Average length is 55 cm at full term.
Blood flow.
How can these conditions be managed?
At-home monitoring, which often requires OB support.
Non Stress Tests (NST), which look at the fetal heart rate to take a snapshot in time of the fetal condition. Persistent accelerations that don't calm down during periods of inactivity indicate that the baby is working hard to get oxygen. This precedes the decelerations that indicate true distress.
Frequent ultrasounds to check the status of the cord.
How can you protect your baby?
Know your normal. Understanding your baby's regular movement cycles throughout a day can help you see a change that means something is wrong. Learn more about fetal movement here!
Lie down as if you are going to sleep. Babies have a reflex for circulation, and when you lie down, your blood pressure changes. Your baby should move within a few minutes to reorient to that change. A lack of movement in this moment can indicate distress.
If anything strikes you as wrong, or strange, go to the hospital and do not leave until you are satisfied your baby is safe.
There is a difference between "screening" and "imaging":
Screening is a test for abnormalities via chordocentesis, which is taking a blood sample from the cord. It can diagnose genetic abnormalities, infections, fetal anemia, Rh disease, blood disorders, or to check fetal oxygen levels. Typically used only in high-risk pregnancies or when other tests are inconclusive. It can carry risks of bleeding, infection, or premature labor. Most practices will not do cord screening unless every other, less invasive, diagnostic test is inconclusive.
REMEMBER: No one knows your baby or your body better than YOU! Trust your instincts, and when in doubt, get checked out.
READY TO LEARN MORE? There's plenty more #empoweredpregnancy goodness where that came from! Head back to the Empowered Pregnancy Overview to for even more empowerment. #UnitedWePush
PUSH EDITOR'S NOTE:
While we'd love to say that you can rest assured that your care team is doing all they can to prevent a cord "accident," it is unfortunately not the standard of care to do most of the above. Until there is a robust body of research that is able to lay out a plan of care that demonstrably lowers stillbirths due to cord pathology without increasing potentially disadvantageous over diagnoses or interventions, there will be no change to the medical system as a whole.
It's up to you, then, to learn more and advocate for your baby if you feel concerned or want to be aware of the condition of your baby's cord. Sadly many of our perfect, healthy babies died at the end of "textbook" pregnancies due to a cord "accident." Many of us have delved deeply into our babies' medical records and received results from independent researchers and OBGYNs that demonstrate the validity of our information above. Many of our babies could have been monitored and delivered alive, through induction or Caesarean, at early term (37-38 weeks) and full term (39-40 weeks).
To be clear, cord anomalies, pathology, and wrapping are not preventable. Practitioners often refuse to image the cord because it will "cause fear" and "nothing can be done" if something is found. But that's not true: if something is found, then the pregnant person is granted agency and information. There can be more frequent monitoring and scans to check the condition, and decisions made specifically for that one individual as needed. Perhaps one baby will survive an induction at 37.5 weeks and another needs a Cesarean at 39. These determinations are impossible to make without information, and without seeing each individual patient as an individual.
Thankfully, people are PUSHING for more: better treatment, better listening, and better research. The R Baby Foundation is launching more cord research, and Dr. Collins, an OBGYN and cord specialist, is always collecting more peer reviewed, substantiated research on his X feed (@jasoncollinsmd77). It's not just PUSH saying a standard of care for the cord is a necessary next step!
In memory of Marian Sedna Wallace-Levitas, we hope you will join our movement to add cord imaging to the standard of care. Become a Changemaker today. 2.14.25 should be Marian's 6th birthday. If her emerging cord pathology had been identified at 36 weeks and then monitored, instead of her lengthy elevated heart rate being dismissed as a blip, she would be here alive and well. We miss her with her family every day. We hope her story and her mother Abigail's advocacy will help save many lives.
Researched & written with love by PUSH Changemaker Abigail Wallace.