Home > Stillbirth > Cord Accidents – Myth or Reality???

Cord Accidents – Myth or Reality???

January 17, 2012 Leave a comment Go to comments

by Lindsey Wimmer    

 

The Star Legacy Foundation is frequently contacted by couples that have been told their child was stillborn due to an umbilical cord accident. Yet, many obstetricians will also say that babies are born all the time with a nucal cord (cord around the neck) and dismiss that as a cause of a stillbirth. Cord issues aren’t just limited to nucal cords – simple compression, cord wraps around other body parts, torsion (twisting to the point of coiling back upon itself like a telephone cord does when twisted too many times), and true knots are also known to cause stillbirth.


Many of the same callers ask us what we know about Dr. Jason Collins and his work involving cord accidents. Dr. Collins, an obstetrician, has dedicated his career to stillbirth research and umbilical cord accidents specifically. The following is a brief summary of a presentation he recently gave at the Stillbirth Summit (October 4-6, 2011 in Minneapolis, MN, USA) which is a very high level overview of his research and conclusions.
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The presence of umbilical cord issues have been well documented in published literature since the 1700s. Yet, this remains an area of obstetrics that is greatly understudied and ignored. The umbilical cord, the insertion site, the placenta, and the baby should be evaluated and characterized with every pregnancy. With advancing imaging technology, it is becoming even easier to identify areas of concern on ultrasound as early as 10 weeks of gestation.

20 week fetus with clearly visible cord

Umbilical cord torsion occurs when the number of twists exceeds the ability of the cord to withstand the force generated. The cord compression generated causes fetal hypoxia (lack of oxygen). On placental exam, chorioangiosis (cellular changes) can be identified as a result of ischemia (restriction) due to cord compression. The length of the cord determines the amount of twisting that is harmful. The human umbilical cord will tolerate one twist per 5cm of cord length. Twists exceeding this ratio are associated with torsion and fetal death. The length of the umbilical cord and the number of twists present should be identified and documented at every delivery. Identification of torsion prenatally allows for altered management of the pregnancy with a better chance of a positive outcome.

There are two types of nuchal cords: type A and type B. Type A is a wrap that can possibly be undone with movement or delivery of the baby. Type B is a hitch that is impossible for the baby to release. If a type B loop around the neck, ankle, or other body part is pushed off the body, a true knot is formed.

With umbilical cord issues, the factor that determines the risk is the amount of slack available. For this to be determined, the cord location, cord structure, placenta, placental position, cord length, insertion site, and position of the baby must all be evaluated and considered. Short cords have been associated with an increased risk of neurologic insults and long cords have been associated with an increased risk of fetal death.

Double Nucal Cord

Work at the Pregnancy Institute has indicated that hyperactivity, hypoactivity, and hiccups may be clinical indicators of fetal distress. Women presenting with these symptoms should be evaluated for sources of cord compression. Fetal heart rate can provide information on this compression as well. Frequent decelerations, W signs, lambda signs, and spikes should be taken as indicators of fetal distress and managed accordingly. The exact amount of time that it takes for fetal chemistry to return to normal after cord compression has not been studied, but we estimate that more than three compressions in ten minutes would create increasing blood chemistry concerns and should be dealt with immediately.

Interviews at the Pregnancy Institute have also revealed that a vast number of fetal deaths occur during maternal sleep between the hours of midnight and 6am. Maternal low blood pressure may play a significant role in this finding as a reduction in blood pressure may alter the fetal response to underlying cord issues. Melatonin is produced during sleep and is known to affect the uterus. During these overnight hours, the melatonin produced stresses the uterus and the baby is challenged. Babies with cord compression may not tolerate this stressor.

Finally, work at the Pregnancy Institute has identified that umbilical cord accidents are not random or rare. Women who have had umbilical cord issues with previous pregnancies, have as much as a ten-fold increased risk of umbilical cord issues in future pregnancies. These women need additional monitoring for these concerns.
Management of umbilical cord issues is possible with proper diagnosis and fetal monitoring.

It is true that not all cord issues lead to stillbirth. However, it is also true that cord issues are a significant risk factor and cause many stillbirths. The evaluation of the umbilical cord and placenta should be included in a new standard of care for obstetrics in the 21st century.

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About the author:

Lindsey Wimmer, a Pediatric Nurse Practitioner, is Mom to four children; Garrett who was stillborn in 2004, Grant, Bennett and Austyn. Lindsey and her husband Trent founded the Star Legacy Foundation shortly after Garrett’s birth when realizing that the numbers of stillbirths in the US were staggering and that very little was being done to determine the causes or find prevention initiatives. Visit the Star Legacy Foundation to learn more.

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  1. January 17, 2012 at 9:32 pm

    Coming from an infectious means of stillbirth background, I found Dr. Collins presentation at the Stillbirth Summit to really be an eye-opener for me as to the scope of the stillbirth problem. Thank you for the summary and please post any updates as they are available.

    • January 17, 2012 at 9:40 pm

      Absolutely Marti – updates will be forth coming! Thanks for your comments. And I must say that likewise, I was greatly enlightened by the presentations provided by Group B Strep International. The Summit clearly highlighted how complex the problem of stillbirth is – and that any one risk factor may or may not singly cause a stillbirth but the odds increase exponentially when multiple risk factors are present and create “the perfect storm.”

  2. Shannon Allgrim
    January 24, 2012 at 10:58 am

    My heart stopped when I read about the Double tight nucal cord, maternal sleep, babies passing away during midnight and 6am. It brought back every memory of the Loss of my daughter Lilly on Sept 14th 2004. She too had the tight nucal cord times 2. She was alive when I went to bed and I knew she passed away when I was sleeping. Thank you for you research. After 7 years, this I believe is my peace of mind an answer. She also hiccuped all the time. Her loss has changed my life forever. She is always missed and our family will never be whole without her.

  3. Lilian kinyua
    November 12, 2012 at 10:22 pm

    The topic is awesome

  4. February 6, 2013 at 10:11 am

    My brother suggested I might like this website. He was entirely right.
    This post truly made my day. You can not imagine simply how much time I had spent for
    this info! Thanks!

  5. RaeAnne Brenneise
    March 7, 2013 at 3:06 pm

    Why aren’t OBs aware of this my daughter just had a angel baby because no one was aware of this. I found out by googling. this needs to be brought to attention before a mother is having to bury her newborn. There is nothing that compares to watching your daughter cry as she rocks her dead baby. This has happened to two families in three months in a town of two thousand people. All mothers need to be monitored All the time not just high risk. This was my daughters first. She had low bp, baby had hiccups all the time, and his heart rate had decreased. They said it was dehydration so they gave her fluids sent her home. he was gone with in 24 hr. February 14 2013 7:10 pm our Angel baby was born. We need awareness! Both our Braxtyn and Ruger (nov 12,12) would be in their families arms not in a cemetery. Caskets that size should not even be needed. I am putting all I can on fb but these should be red flags for all obgyns and ERs
    Families should not have to go thru this all the signs were there, but no one knew the signs!!! We need to stop this in all the technology this should be a thing of the past!!

    • March 7, 2013 at 3:53 pm

      RaeAnn,
      I am so very sorry about your loss. You are so right about so many things – that no mother should have to witness her own baby rocking her dead baby; that all pregnancies should be considered high risk with the best monitoring and prenatal care available. These things are precisely why the Star Legacy Foundation was started – in an effort to encourage stillbirth awareness, research and prevention strategies. Please visit our website at http://www.starlegacyfoundation.org to learn more about our efforts.
      Please call upon us if there is anything we can do to support you and your family.

    • amie
      April 10, 2013 at 4:52 pm

      I voiced my concerns in tears with my nurse over the phone and was basically told “you have an appt coming up Im sure everything is fine… i felt something was going terribly wrong in my gut yet I was dismissed. I went for an OB appt 1 week later and delivered my son at 17 1/2 weeks due to “a cord incident” the next day. I was happy to find this site and discussion as well. I feel deeply for your loss.

  6. Bridget
    July 5, 2013 at 8:05 pm

    Do you guys have any research on coiled index with the cord? I just lost my baby last Tuesday, June 25th at 22 weeks and based on the pathology report on my placenta, my cord was over coiled and there was also a clot as a result. I can’t find any good solid research on this and if it is something that might happen again. I am desperate for help.

    • December 30, 2013 at 2:43 pm

      The Pregnancy Institute has done work on hypercoiling of the umbilical cord, but otherwise, there is very little research. What we do know is that it can reduce the blood flow through portions of the cord and is also easier for the cord to ‘kink’. We hear stories from women who have had repeat cord issues, but there is not sufficient research into how much this occurs or how or why. Many of these issues can be identified via ultrasound and then managed based on how the baby is doing, etc.

  7. Dana
    July 6, 2013 at 9:33 pm

    Hi. I had a baby born still in October 2005. It’s absolutely absurd that doctors do not routinely warn their patients about the risk factors of stillbirth or check the cord with an ultrasould. I had low blood pressure, and a doctor joked with me, “No wonder you’re tired. You’re almost dead.” My BP was sometimes 60/40 while I was pregnant. Two pregnancies went fine. Then I lost Savannah. She was hiccuping in my OB/gyn’s office the morning before she died, and the doctor joked that it was like she was knocking to get out. DUH! Those hiccups are not a joke. The next day, she was not hiccuping. We went for an ultrasound, and the US tech pointed out that what should have been lighting up like a Christmas tree was not. She had no blood flow. I pray that doctors will open their eyes and protect babies and their families from this horror.

  8. Andrea
    September 6, 2013 at 7:02 pm

    My sweet angel was born sleeping due to a knot in his umbilical cord. I felt a decrease in fetal movement and went in later that night and was told baby had no heartbeat. I was nearly 39 weeks when I heard the news, I was devastated. From what I read above my future pregnancies have an increased risk of same problem? I dont think i could go through that again. How many studies are that statistic? – Worried sick

    • Leslie
      November 4, 2013 at 11:51 pm

      Dear Andrea; In 2001 my daughter lost her baby boy at 40 weeks pregnant due to a cord accident. Devastating. Ten years later she gave birth to a healthy baby girl and this year a baby boy. She is proof that it is possible to go on to have more children. I really hope this gives you faith to try again, if that’s your wish <3

    • December 30, 2013 at 2:50 pm

      I am so sorry, Andrea. It is true that statistics show women who have had a previous poor pregnancy outcome (includes premature birth, stillbirth, neonatal loss, etc) have a higher risk of a poor outcome in future pregnancies. What the actual numbers are vary from study to study and differ depending on what the cause of death was, or if a cause is known. Many times, the reason for the increased risk is not explainable. This is the main reason why most pregnancies after a loss are monitored as ‘high-risk’ with a different protocol for care from ‘routine’ pregnancies.

  9. Nuriana Pimentel
    December 12, 2013 at 10:17 am

    Hi, I’m so happy to finally see an article that makes sense to me. I just gave birth to a stillborn baby boy at 28 weeks and had no answers except he had the cord wrapped twice around his neck. He was my 3rd and sadly due to complications from the csection my last. No one, until I read this article had been able to give me feedback, I too had low BP, and he had hiccups the day it happened and decreased movement and like most it’s interesting he stopped moving between 12-6 a.m..How come Drs. are not made more aware of this, I called my OBGYN and was informed to come in the following day for my symptoms were not uncommon . I knew something was wrong, maybe if my cord had been monitored more in the ultrasound my angel would be with us now. This info needs to get out there and that way many future losses prevented.
    Still grieving Anne.

  10. Lillie
    December 29, 2013 at 11:19 pm

    My son was born on Dec 18th with a true double knot in his umbilical cord by csection. His estimated weight by ultrasound 2 months prior was 8 1/2 lbs but was born at 6lb 6oz at 39 weeks. god blessed us and he survived but now I am worried about if there are long term affects due to the knots. Any info on this would be greatly appreciated.

    • January 3, 2014 at 1:53 pm

      Hi Lillie – Thank you for sharing your story. You are exactly right that these events during pregnancy can have effects we don’t immediately see. There are several studies looking at all types of interrupted blood flow during pregnancy. Ultimately – there isn’t a way to predict because it all depends on the severity and duration of the issue along with the timing of the pregnancy. However, there are also many studies that prove the amazing ability of a baby’s brain and neurologic system to overcome many challenges. In any case, early detection and treatment always provides the best opportunity for minimizing poor outcomes. Your awareness and vigilance is a great sign for your son! I would encourage you to provide age-appropriate toys that will stimulate his senses and promote neurological development. Talk to your pediatrician for specific suggestions. Be sure to mention any questions or concerns you have about your son’s development with your pediatrician. Congrats and I wish you the best!

  11. January 11, 2014 at 10:27 am

    My daughter and her husband had an angel baby 1-8-14. She measured at almost 21 weeks, but she was supposedly 29 weeks along in the pregnancy. She had concerns about her small belly size, but her OB did not seem concerned at her 24 week checkup. This was her first pregnancy. She was also diagnosed at the beginning of her second trimester with ulcerative colitis, which caused a lot of stomach issues which mimicked the feeling of the baby moving. When little Brynn was born, the cord was around her neck, which her doctor said could have been the cause of death. Her placenta is being tested for many things to see if there were other issues. We are hoping for the result of those tests in a few days. I am wondering what the normal length of the umbilical cord is at 21 weeks gestation due to the fact that my sister lost her first baby due to an unusually long umbilical cord. Is this type of thing hereditary in any way? Just wondering.

    • January 28, 2014 at 4:13 pm

      According to Dr. Jason Collins of The Pregnancy Institute, the baby’s cord should be the length of the baby after 12 weeks of gestation. There is some speculation that there may be a hereditary or familial component to many cord issues, but it just hasn’t been studied well enough to say for sure. I hope you will be given answers for your loss.

      • February 9, 2014 at 9:20 pm

        I appreciate the reply.

  12. pam
    February 27, 2014 at 2:59 pm

    my daughter just lost her baby girl at 33 weeks she has turner syndrome had ivf with sucess all was fine till her bp went up dangerouly high she saw her cardiolist that afternoon he sent her right through emergency they kept her and she knew something was wrong she was scheduled for a csection in march she wanted them to do the csection and take the baby out but they didnt and she passed away the nurses had checked at 2am there was aheartbeat thenthey shut the heart monitors off and at 4am they could not find a heartbeat they scheduled her that morning after the baby was gone to do the csection we were told it had nothing to do with bp but it was a cord injury the cord was wrapped around her ankle but we feel 1 they should have taken and done a csection the night before becase she was high risk and 2 they should have never shut the heart monitors off it would have almed them the babys heart stopped we feel this could have been prevented their reson they thought the baby better off inside mother as long as possible i just wish they would have done a csection the night before they had given the baby something for her lungs i think in case they took her but my daughter ate and she could have had trouble if they took and operated but my daughter and her husband are devasted they are going to try in a year the baby had hickups prior as well if anyone has had this happen especially having turner syndrome please let me know thanks

  13. Laura
    March 9, 2014 at 3:43 pm

    I lost my baby girl on 11-17-13 from an umbilical cord accident. My husband and I are desperate to try for another baby. I have had two c-sections, one 5 1/2 years ago and one in Nov. 2013. Does anyone know of a suggested wait time before trying again? I would love to hear what Dr. Collins suggests.

    • lindseywimmer
      March 10, 2014 at 5:51 pm

      I’m so sorry for your loss. I’m not positive what Dr. Collins would say, but the literature and experts don’t provide a clear answer. I would say it depends mostly upon if a cause was identified for your daughter’s death. If so, your physician may suggest treatments, testing, genetic counseling, or other items to reduce or evaluate any future risks. The second major factor would be when you feel emotionally ready to enter another pregnancy. Of course, pregnancies after loss are always stressful, but some people feel better ready to handle that anxiety after more time than others. Again, research says various things about the timing, but I believe it is very individual. Finally, I would suggest having a meeting with your OB to discuss any questions or concerns you have including what the plan is for your next pregnancy. Many parents and many OBs have different ideas about what should be done the same or differently – and it is easiest to have this discussion and create a general plan before you are pregnant (or very far along into the pregnancy). If you and your OB do not agree on how the next pregnancy should be handled, it is acceptable to interview other providers until you find one that meets all of your physical and emotional needs.

  14. April 10, 2013 at 5:23 pm

    Aimee – the best person to discuss your case with would be Dr Jason Collins of New Roads, LA. He has dedicated his entire obstetrical career to stillbirth. He is always happy to visit with moms. If you want to contact me at info@ starlegacyfoundation.org I will send you his contact information. I’m so very sorry for your loss. Please know we will keep you in our thoughts.

  15. amie
    April 11, 2013 at 8:55 am

    Wow thank you so much for your reply

  16. Tina Rose
    November 12, 2013 at 12:50 pm

    Just looking at this blog as I was on the hunt for more information about cord accidents. My baby died just a few days before term of a cord wrapped many times round their ankles. The doctors and midwives I have seen said they have never seen it before. The one thing that is a comfort within the devastation of loosing a child is that there was a reason.
    I am interested to know if this statistically more likely to happen again. As well as measure and monitoring that can be taken to prevent it if statically it is more likely.
    It’s interesting you say that 12-6 is the most likely time as I woke up in the middle of the night and went to hospital as I felt there was something wrong.

  17. December 30, 2013 at 2:55 pm

    The numbers vary, but studies will say that women who have experienced a stillbirth have anywhere from twice the risk to 10 times the risk in subsequent pregnancies. The reasons for this aren’t known. A subsequent pregnancy should be considered ‘high-risk’ with an appropriate protocol. I’m happy to send you articles that outline this protocol if you’d like – but it generally involves more frequent visits, additional testing/monitoring, etc.

  18. February 6, 2014 at 4:09 am

    Hi Lindsey,
    Yes if you could send me more info that would be great thanks

  19. February 21, 2014 at 2:43 pm

    Hi Tina – send your email address to me at lindsey@starlegacyfoundation.org and I’ll send you the info. :)

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