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3.7 kg baby boy was born with a knotted umbilical cord

Doctor of Obstetrics and Gynecology at Tam Anh General Hospital in Ho Chi Minh City discovered the rare umbilical cord knot, cesarean section, saving the newborn from the risk of fetal distress, postpartum asphyxia.

Pregnant woman Tran Linh Phung, 29 years old, living in Ho Chi Minh City, was pregnant for the first time, showing signs of labor, so she was hospitalized at 39 weeks 3 days, in a completely healthy condition. Ms. Phung was advised by doctors to have a caesarean section due to the large fetus. During the cesarean section, doctors accidentally discovered a dangerous umbilical cord knot, which puts the baby at high risk of fetal distress, postpartum asphyxia, and even stillbirth.

The doctor suddenly discovered a deadly knot in the caesarean section.  Photo: Tam Anh General Hospital.

The doctor suddenly discovered a dangerous umbilical cord knot during a cesarean section. Photo: Tam Anh General Hospital.

MSc Ngo Binh Lua, a doctor at the Center for Obstetrics and Gynecology of Tam Anh General Hospital in Ho Chi Minh City, said: The umbilical cord is the way to supply blood, nutrients and oxygen to the fetus. If the umbilical cord is knotted, blood and oxygen will not be supplied enough or is completely blocked, the fetus will be in danger, at risk of death. Complications of umbilical cord knotting can occur before birth and during delivery, often requiring immediate medical attention to prevent fetal death in utero.

In Phung’s birth, although the umbilical cord knot is not tight, blood and oxygen can still circulate, but if the birth is normal, fetal heart rate fluctuations may occur during labor. The baby can face the risk of respiratory failure, in danger because the knotted umbilical cord does not provide enough oxygen and blood.

According to Dr. Lua, on prenatal examination, pregnant women have completely normal indicators with a gestational age of 39 weeks 3 days; Fetal heart rate 137 beats/min, head position, amniotic fluid, abdominal contraction 1-2 beats/10 minutes, pink viscous; cervical dilation 1-2cm thick and soft. Ms. Phung can give birth naturally, but because the fetus is quite large (about 3.7 kg) and the pelvis is slightly deviated from the pregnancy, the doctor recommends a cesarean section to avoid bad risks.

At birth, the baby had a slight difficulty breathing, was deprived of oxygen, only 92% SpO2 test, there were signs of respiratory failure. The Neonatal Center doctors skipped the skin-to-skin approach and took the baby right to the neonatal intensive care unit (NICU) for intensive care, thereby ensuring safety. Currently, the baby’s condition is stable, suckling well, does not need special care because the baby is no longer dependent on the source of oxygen and nutrition from the umbilical cord.

“Although the umbilical cord was discovered by accident during surgery, looking back at the prenatal process, the indication for an immediate cesarean section was correct. If a woman gives birth normally the next day, I don’t know what will happen. “, Doctor Lua added.

How dangerous is the umbilical cord knot?

According to Dr. Binh Lua, the risk of death in the group of fetuses with knotted umbilical cord was 5 times higher and there was no prior prediction. The knotted umbilical cord is like an “unexpected accident” in obstetrics, often when events such as stillbirth occur, especially in the last 3 months of pregnancy or the time of labor, the doctors have just recovered. found that there was umbilical cord knotting.

Close-up of dangerous umbilical cord knot in a fetus of 39 weeks, 3 days.  Photo: Tam Anh General Hospital

Close-up of dangerous umbilical cord knot in a fetus of 39 weeks, 3 days. Image: Tam Anh General Hospital

Umbilical cord knots have an average incidence of about 1 in 100 and most cases are discovered incidentally. Knots are formed during fetal movement, sliding through a loop of wire.

According to Dr. Silk, some studies in the literature show that knotted umbilical cord is related to male fetus, long umbilical cord, pregnancy past due date, gestational diabetes, chronic high blood pressure, multiple births , polyhydramnios, and related maternal age, anemia, diabetes, history of previous miscarriage. High-risk pregnant women such as twins (single placenta, monoamniotic fluid), ie two babies sharing the same placenta and one amniotic fluid, the umbilical cord ring is often twisted due to physical impact in the uterus. The risk of the umbilical cord being twisted or the umbilical cord knotted in cases of twins is up to 90%, so around 32-34 weeks, doctors had to cesarean section early.

However, singleton pregnancies with umbilical cord knotting are rare, mostly occurring in women with excessive amniotic fluid, polyhydramnios, long cords, or low birth weight babies. Phung’s case did not have these factors, so no one expected that there was a dangerous knot.

According to Dr. Silk, ultrasound can detect umbilical cord knots, but the sensitivity is not high. For example, if the umbilical cord positions are too close together, the ultrasound image may not be clear, or the umbilical cord jelly in the early stages can be fused together, which can also create a false image. When the ultrasound shows a sign called a typical noose sign, the half of the umbilical cord is crossed, the sonographer can conclude this is a case of knotted umbilical cord. This means that doctors are often left on the defensive in situations where the cord is tied. Therefore, the quick, methodical handling of the baby as soon as it comes out of the womb is decisive in helping the newborn baby avoid dangerous risks, causing lifelong disability or sequelae. death threat.

At the Center for Obstetrics and Gynecology, Tam Anh General Hospital, Ho Chi Minh City, when pregnant women go to the delivery room, the cervix is ​​dilated about 2-3 cm, and they will be fitted with a continuous fetal heart monitor. During labor, when the fetus begins to descend, if the umbilical cord is knotted, causing hypoperfusion, the fetal heart rate fluctuations will be recorded on the monitor. Thanks to that, the doctor can timely detect the umbilical cord compression, which is getting worse and worse, with the risk of pregnancy failure, to appoint an emergency surgery immediately. In addition, every hospital birth is attended by a pediatrician, and even high-risk births are picked up by a pediatrician. For example, in the case of 5 months pregnant, the golden hour postpartum regimen is that the pediatrician resuscitates the baby at the table.

A healthy baby boy returns to his mother's arms after a day of intensive care at the Newborn Center of Tam Anh General Hospital in Ho Chi Minh City.  Photo: Thanh Truc

A healthy baby boy returns to his mother’s arms after a day of intensive care at the Newborn Center of Tam Anh General Hospital in Ho Chi Minh City. Photo: Thanh Truc

Preventing the risk of knotting the umbilical cord

Doctor Silk said that usually, if the umbilical cord knot is detected on ultrasound, the doctor will evaluate the fetal health very carefully, such as giving color Doppler ultrasound, checking the perfusion in front and behind the position. knotted umbilical cord position; fetal heart rate measurement; fetal health check.

For a full-term gestational age, the doctor will guide the mother to pay attention to the fetal movements carefully and give detailed advice for each specific case, that is, individualized for each pregnant woman so that they can Decide for yourself how to give birth safely. With a pregnancy from 26 weeks, pregnant women can monitor and count fetal movements 3 times a day, morning, noon, and afternoon after eating. Pregnant mothers who are too busy, just need to pay attention if within 12 hours, the baby has more than 10 fetal movements, which is normal, or the mother spends 1-2 hours in the evening to rest, lie quietly, then Notice baby machine over 8 times is normal.

In addition, after the 36th week of pregnancy, pregnant women should have a prenatal check-up once a week until the due date at 40 weeks. The doctor will appoint a hospital admission for overdue pregnancy on a case-by-case basis. 1-2 days before the due date, pregnant women should be admitted to the hospital as directed by the doctor.

For high-risk pregnancies such as twins sharing the same placenta, sharing the same amniotic fluid, a lot of amniotic fluid, long amniotic cord or diagnosed with umbilical cord torsion, you must see a doctor for follow-up.

Nguyen Phuong

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