The umbilical cord is a narrow tube-like structure that transfers nutrients and oxygen from the placenta to the fetus, and removes the waste matter from the baby to the placenta. It contains two arteries and a vein which aid in its proper functioning, along with a gelatin-like cushioning known as the Wharton's jelly that provides a protective covering over it. The cord starts forming five weeks after conception, and keeps increasing in length till about 28 weeks of pregnancy. As the length of the cord increases, there are many complications related to umbilical cord that may arise along the course of pregnancy. One such umbilical cord complication is when the cord is looped around the baby's neck in the womb. Also known as a nuchal cord, this common pregnancy complication occurs in ten to thirty-seven percent of all births. Although the complication is rarely associated with any adverse outcome, in certain cases when the cord is tightly wound around the neck, there might be fetal distress and variable fetal heart rate decelerations during labor. Classification of Nuchal Cord Based on how the nuchal cord is wrapped around the baby's neck, it is classified as Type A and Type B. Type A which is the most common type of nuchal cord complication is when the cord is loosely wrapped around the baby's neck in 360º. On the other hand, Type B is when there is one or more true knots that are formed when the umbilical cord is pulled through the nuchal loop. The chances of a true knot increases when there are twins or when the baby is extremely active in the womb. Depending on how the cord is looped around the baby's neck, the doctor may decide on the appropriate course of action. Usually during pregnancy there are no complications associated with cord around neck. However, during labor when the uterus shrinks to allow the baby to move out from the uterus and into the vagina, the nuchal cord can tighten and get stretched. This in turn might lead to complications like inability of the blood vessels to supply oxygen and short-term hypoxia. Intervention in case of nuchal cords is sought in the following ways.

• Vaginal examination to check for cord around baby's neck
• Pulling and unlooping a loose nuchal cord
• Clamping and cutting the cord in case of tight nuchal cord
• Somersault technique of birth

Vaginal Examination A common medical practice, vaginal examination to check for nuchal cords is usually done after the birthing of the head, sometimes without the consent of the mother. This can be painful for the woman, and can also interfere in the birthing process. It can also cause trauma to the perineum. Loosening The Cord This is a common birth intervention for loose nuchal cords. During this process, the doctor manually slips back the cord over the baby's head to free it. If there are multiple loops around the neck, the process might take more time. Associated Risks: There are certain risks associated with this method as well. Handling the umbilical cord might cause the blood vessels to vasoconstrict, thus leading to low blood supply. Sometimes while loosening the cord, the umbilical cord may develop a slight tear and there might be associated bleeding. Clamping and Cutting the Cord When the nuchal cord is very tight, the doctor might clamp and cut it. To do this, the doctor would place two clamps on the umbilical cord and severe it from between. Associated Risks: Once the umbilical cord is clamped and severed, the blood flow between the baby and the placenta stops. This causes a drop in the baby's oxygen supply and blood volume. Any delay in birth caused by factors like shoulder dystocia can increase the risk of hypoxia and neonatal hypovolemia for the newborn. The diminished blood flow can lead to a drop in the iron content. The babies are born with irregular respiration, weak peripheral pulse, tachycardia and low APGAR scores. Resuscitation in the form of intubation, ventilation and blood transfusion would be needed to keep the baby healthy. Somersault Technique of Birth This is a technique of birth which involves holding the baby's head flexed during the birthing process and guiding it upwards towards the thigh or pubic bone of the mother. This results in the baby's feet being positioned towards the mother's knees while the head is still near the perineum in a 'somersault' position after birth. The cord is now loosened. As a parent it is easy to get worried when there is a cord wrapped around your unborn baby's neck. It is best to discuss the methods of intervention with the medical care provider when the nuchal cord is detected during pregnancy. Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical professional.