The “turns” of cord and death in utero

by Claudia Ravaldi

Interview with Dr Jane Warland , Australian midwife who has been involved in perinatal bereavement for many years. In the interview, Dr. Warland discusses the complex issue of the umbilical cord as a cause of stillbirth.

The article, published by the Star Legacy Foundation , was translated by Rossella Errico and revised by Claudia Ravaldi.

Australia seems to have a diametrically opposite position with respect to the cordon to that of Italy.

In fact, in Italy there is a tendency to attribute the majority of stillbirths in an a priori manner to an exclusive cord problem; this implies, as a direct effect, to consider the case “closed” and not to investigate further, not even in cases in which it would be desirable to carry out the necessary checks on the placenta and on the mother.

In Australia, on the other hand, as Dr. Warland explains, the cord problem is always considered a contributing cause, and never in itself a direct cause of intrauterine death.

In reality, as can be seen from the article, the cord can be involved as a direct cause or as a contributing cause in term or peripartum stillbirth.

Let’s try to understand better, thanks to the words of Dr. Warland:

“As a midwife I have seen many babies born alive and healthy with their umbilical cord around their necks. I have also read several comments from women, on facebook or other social networks, who asserted:” my baby was born with a cord around his neck and it looks great! ”, thus minimizing the fact that the cord can be a problem.

Personally, I experienced the other side of the coin. In fact, my daughter Emma was born dead with the cord around her neck. Although I never thought that was the only reason for his death I think it probably contributed, as I will explain later.

I worked as a midwife on the South Australian Perinatal Subcommittee . This commission takes into account stillbirths in Southern Australia and ranks causes of death. While working on the commission I had the privilege of learning from the wonderful Dr. Yee Khong (fantastic perinatal pathologist from South Australia) the clinical signs that show up in the stillbirth cord, indicating that the cord played a possible role in death. of child.

The cord around the neck is rarely considered the sole cause of death, even if it plays a fundamental role; it is usually considered a contributing factor (contributing factor) .

To the question “Could the cord around the neck be a problem or not?” The answer is “It depends”.

Depends on what?

There are at least 3 aspects to consider with great attention.

1) How the cord is twisted around the neck

2) The vulnerability (predisposition) of the child

3) Other factors such as the position of the placenta, the length of the cord, the amount of Warthon’s jelly, the ” shape of the cord ” and the position of the baby in utero.

Types of kinking

Jason Collins has worked a lot in this field and describes 2 types of cord

Type A cord: wraps around the neck but can melt.

Type B cord is knotted at the neck and can be tightened.

It knots and tightens when the baby naturally begins to channel into the pelvis to prepare for birth around the 36th week and also when the baby begins to descend in delivery. If the child has a type B cord, they have a higher chance of complications than type A. Why? Well, type A can easily slip through the body as soon as the baby moves or while he is channeling to be born; in contrast to the type B cord will tighten e it could cause such pain that a caesarean section is required, and by squeezing and locking, it could put the baby’s life at risk.

Can women who are about to give birth know if the baby has a type A or type B cord? The cord can be seen during the ultrasound, if you look carefully!

Vulnerability

The baby who dies in utero often suffers from a combination of factors that together can lead to death. We know some factors that make the baby vulnerable, such as stunted growth, or reduced fetal movement, but there are many factors we don’t yet know well that can make a baby vulnerable. Looking at the figure we can easily understand that if the baby is already vulnerable, has a type 2 cord around the neck, has a posterion placenta, a thin cord and the mother sleeps regularly on her back, all these factors combined can be fatal for that child.

Other factors

There are many other factors that can make the cord around the neck problematic for a small number of children.

These factors are: the position of the placenta, the length of the cord, the amount of Warthon’s jelly and the ” shape of the cord ” as well as the position of the baby. In short, if the cord is of normal length, fairly spiraled (not too much), has three vessels and a lot of Warthon jelly, then the chances of the baby being born alive are very high, while if the cord is long, thin, not spiralized. and with little Wharton’s jelly the risks of complications are remarkably high.

More information can be found in Dr. Collin’s book ” Silent Risk ”

Summary

So is the cord around the neck a problem for all children?

No , if it is not associated with other risk factors (such as those listed above).

If a child is born dead with one (or more) of a cord around the neck, is this sufficient to explain his or her death?

No , it is necessary to carry out the diagnostic investigations provided to identify other risk factors and other possible contributing causes that may be associated with a recurrence in a subsequent pregnancy.

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