Umbilical cord complications can endanger a baby’s life, especially if doctors and other medical providers fail to catch them in time.
The umbilical cord is the baby’s lifeline during pregnancy. Attached to the placenta, the cord is the vessel by which blood, oxygen, and other nutrients travel from the mother to the baby. If a child’s access to these nutrients is disrupted, they are at risk of developing several hypoxic (lack of oxygen) and ischemic (lack of blood flow) injuries. Major disruptions can cause hypoxic-ischemic encephalopathy (HIE), a severe type of brain injury cited as leading cause of cerebral palsy.
More severe umbilical cord complications may require an emergency c-section delivery, or require external tools such as the use of forceps and vacuum extraction. This action may sometimes be required before the child is fully developed, exposing them to the risks that come with premature birth.
Medical providers must understand how umbilical cord complications occur, how to treat them, and how they might be prevented so that at-risk babies can avoid a severe birth injury. If they fail to do this, it may count as medical malpractice.
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Birth Injury settlement against a hospital in which nurses and physicians failed to properly monitor the mother's blood pressure during delivery causing an HIE event resulting in neonatal seizures and cerebral palsy at birth. Our national birth injury lawyers recovered $13,750,000 for the family to help with future medical expenses and developmental therapy.
What Does the Umbilical Cord Do?
Most of the umbilical cord interior consists of a gel-like connective tissue called Wharton’s jelly. This jelly protects and surrounds two umbilical arteries and a large umbilical vein.
The umbilical cord does not actually connect the baby directly to their mother. Instead, the placenta acts as a sort of intermediary, taking in the nutrients from the mother and then supplying it to the unborn child via the umbilical cord.
Oxygenated blood flows through the umbilical vein from the placenta to the child. After passing through the baby, the umbilical arteries carry out deoxygenated blood (blood containing carbon dioxide) back to the placenta. After they’re born, most babies have a respiratory system that’s developed enough for them to breathe on their own.
A typical umbilical cord in a full-term infant is about 20 inches long and 0.75 inches in diameter.
Doctors, midwives, nurses, and other healthcare professionals should be aware of potential umbilical cord complications. They must not only watch for them, but properly diagnose these complications and act to either correct them or deliver the baby to eliminate any ongoing damage.
What Are Common Umbilical Cord Complications?
Most umbilical cord complications involve one of three factors:
Length (a cord that’s either too long or too short)
Positioning (a cord with knots, compression, or one that’s wrapped around the baby’s neck)
Placental Insertion (a cord that’s only partially attached to the placenta, or not attached at all)
Other issues like vasa previa and umbilical cord infection can also complicate a mother’s pregnancy and the delivery of her baby.
Many umbilical cord complications are identified during pregnancy, giving doctors time to plan for them. But some complications occur during labor and delivery. In such cases, labor and delivery medical teams must be able to detect problems and address them immediately to prevent damage to the baby.
If needed, they must be prepared to perform an emergency c-section or use external tools like forceps and vacuum extractors if the umbilical cord complication is preventing the child from exiting safely through the birth canal.
Nuchal Cord
A nuchal cord is an umbilical cord that is wrapped around the baby’s neck. This complication is fairly common, estimated to occur in between 20% and 30% of all pregnancies.
A nuchal cord can develop from a baby’s increased movement and turning while in utero. Certain factors like a mother’s low blood sugar or excess amniotic fluid in the womb can increase her baby’s movement. As the child turns, spins, and flips around, they can get tangled up in the umbilical cord and inadvertently wrap it around their neck.
In many nuchal cord cases, the cord is loose enough for the baby to slip out of naturally. Sometimes the doctor can even unwrap it themselves during delivery. But more serious cases of nuchal cord can cut off blood flow to the child’s brain.
An umbilical cord length of 14 inches or less is considered too short. Excessive fetal movement with a short umbilical cord may pull too hard on the mother’s placenta, increasing her risk of a placental abruption. It can also put the umbilical cord at risk of tearing or rupturing, which would have catastrophic effects to the baby’s viability. Additionally, tears to the umbilical cord or the placenta can cause internal bleeding and put the mother’s health at risk.
Cords measuring more than 80 centimeters (roughly 31.5 inches) are considered too long. It can usually be observed through ultrasounds during prenatal checkups.
An abnormally long cord doesn’t inherently harm the child. But it can sometimes act as a catalyst for triggering other umbilical cord complications for the baby, including umbilical cord prolapse, nuchal cords, and true knots. Doctors, nurses, and other healthcare providers must be aware of these risks and must be prepared to quickly respond and treat them in the case of a medical emergency.
True Knot
As the name implies, this umbilical cord complication involves knots that form on the baby’s umbilical cord. Doctors should carefully review ultrasounds to see if knots have already formed. However, some knots develop during labor and delivery.
An umbilical cord true knot can form from the baby’s natural movement and repositioning within the womb. But other factors can increase the risk of one forming, including polyhydramnios, a gestational diabetes diagnosis, or having an unusually long umbilical cord.
True knots can be dangerous to the baby. The knot can compress the blood vessels in the cord, compromising the baby’s supply of blood, oxygen, and nutrients, potentially causing poor fetal development, fetal distress, and brain damage.
A decrease in fetal activity and movement can be a sign of a true knot in the baby’s umbilical cord. Medical professionals must actively monitor the child’s heart rate in the critical weeks leading up to the mother’s due date so they can know when to intervene. In some cases, a true knot blocking the flow of nutrients to the baby may require doctors to perform an emergency c-section delivery.
Umbilical Cord Prolapse
Normally, the baby is born before or with the umbilical cord. Complications arise when one or more loops of the cord slip through the cervix before the baby. The prolapse often completely compresses the cord, which reduces or stops the flow of blood and oxygen to the baby.
When this happens, doctors, nurses, and midwives need to consider it an obstetrical emergency and take immediate action to deliver the baby. Failing to perform an emergency C-section could damage the baby’s brain or even be fatal.
Umbilical Cord Compression
This is a serious umbilical cord complication, whether it happens before or during childbirth. The blood, oxygen, and nutrients flowing through the cord are essential to the baby’s development and wellbeing.
The cord is naturally compressed during a mother’s contractions. However, when compression goes on too long, the baby’s heart rate may exhibit signs of fetal distress, and birth trauma.
Sometimes compression can be caused due to another existing umbilical cord complication, such as a true knot, a nuchal cord, or a prolapsed umbilical cord during labor.
Doctors and nurses reading fetal monitors should recognize the signs and intervene immediately. If interventions do not quickly decrease compression, the mother may need an emergency C-section.
Marginal Cord Insertion
Normally, the umbilical cord attaches to the center of the placenta, which is the thickest and most secure spot for attachment.
Marginal cord insertion (MCI) is an abnormal type of cord insertion where the umbilical cord attaches to the edges of the placenta. The placenta’s edges are thinner and can slow the delivery of vital nutrients.
Marginal cord insertion can stunt a child’s growth if it blocks them from receiving a sufficient flow of blood, oxygen, and nutrients in the womb, increasing the risk of complications like low birth weight and difficulties with breathing.
Velamentous Cord Insertion
In rare cases, the umbilical cord doesn’t insert into the placenta at all. Instead, it inserts directly into the fetal membranes outside of the placenta. This is a medical condition called velamentous cord insertion (VCI).
While rare, velamentous cord insertion is more commonly observed in twin pregnancies, especially monochorionic diamniotic twins (twins sharing the same placenta). Other risk factors include pregnancies involving in vitro fertilization and cases of placenta previa (where the placenta attaches lower than regular in the uterus).
Velamentous cord insertion forces blood vessels to travel much farther without the protection of Wharton’s jelly. This makes the exposed umbilical cord blood vessels more likely to burst and bleed, which would have catastrophic consequences to the baby’s wellbeing.
In some cases of velamentous cord insertion, a doctor may deem it necessary to conduct an emergency c-section to avoid any potential injury to the cord or the baby.
Vasa Previa
Vasa previa is a rare pregnancy complication where one or more of the umbilical cord blood vessels exists outside the umbilical cord and is close to or running across the cervical opening. It can be caused by a case of velamentous cord insertion (categorized as Type I vasa previa).
The main concern with vasa previa is that these exposed vessels could rupture, especially when the mother’s water breaks. This can cause severe internal hemorrhaging for the mother and blood loss for the baby, which can result in death.
Vasa previa can be caught during regular prenatal ultrasounds and before labor commences. If undetected or ignored, it can result in fetal distress or death.
Infections
Intrauterine infections like chorioamnionitis affect a pregnant woman’s placenta. The infection can affect the flow of oxygen and nutrients to the baby, damaging the baby’s heart, lungs, brain, and other organs.
Additionally, the umbilical cord itself can become infected, a condition known as funisitis. This typically occurs after fetal membranes get infected and it spreads to the umbilical cord. An infection of the cord blood vessels is called umbilical vasculitis. The bacteria that cause these complications are usually the same types that put the mother at risk for maternal infection (group B strep, listeria, etc.).
The umbilical cord’s importance to fetal development should make identifying and treating umbilical cord complications a top priority for all medical professionals.
How to Diagnose An Umbilical Cord Complication?
Doctors and medical providers can use ultrasound to diagnose many conditions affecting the umbilical cord. When diagnosed early, medical intervention could prevent a minor issue from becoming a life-threatening complication.
Prenatal monitoring of the fetal heart rate is also important. Abnormal fetal heart monitor results can indicate that an unborn baby is suffering hypoxia (reduced oxygen) or anoxia (oxygen deficiency).
Medical staff routinely attach two electronic fetal monitors to the mother during labor and delivery. One monitors the mother’s contractions. The other monitor tracks the baby’s heart rate, especially when reacting to contractions. A decreased heart rate could indicate cord compression or other umbilical cord complications. Additionally, too long of contractions or too many contractions over a given time period (hyperstimulation) can cause cord compression and hypoxia.
A prolapsed umbilical cord should be detected when the doctor conducts physical examinations of a mother during labor.
Failing to monitor mothers undergoing labor and delivery is medical negligence, especially when signs of umbilical complication are present. An experienced birth injury lawyer can help families who experienced medical negligence explore potential medical malpractice claims.
Treating Umbilical Cord Complications
Whether a condition can be treated or managed depends on the type of complication. Some conditions can only be monitored, like a known nuchal cord or vasa previa. The doctor might only be able to act in emergency situations.
Infections can be treated as soon as they are identified. But the expectant mother’s medical team typically would need to increase monitoring of the mother and baby to intervene quickly.
When a baby appears to be in fetal distress because of umbilical cord compression, doctors and nurses might first try changing the mother’s position. They should then analyze electronic fetal monitor results to see if the baby’s heart rate has recovered. If not, then other treatment is needed immediately.
An emergency C-section must be done in some situations, including umbilical cord prolapse and compression. Otherwise, the baby could suffer hypoxic-ischemic encephalopathy due to a lack of oxygenated blood flow to the baby’s brain.
Where Medical Providers Go Wrong
Proper medical care begins with prenatal visits. Doctors, nurses, and other medical staff should get the expectant mother’s complete medical history. Blood and urine testing can give a picture of the mother’s health. Ultrasounds help identify potential problems with the unborn baby. Additional tests might be done when umbilical cord complications or other pregnancy complications are possible.
Some umbilical cord complications can be caught early. After detection, doctors should monitor at-risk mothers and babies more closely. Otherwise, life-threatening situations could arise that cause brain damage, cerebral palsy, developmental delays, and seizure disorders.
Finally, umbilical cord issues may arise during labor and delivery. At all times, medical professionals must closely observe their patients and meet their duty of care to recognize and respond to fetal distress caused by cord complications.
Possible examples of medical malpractice regarding umbilical cord complications include:
Failing to conduct adequate prenatal checkups and missing an umbilical cord complication.
Failing to recognize an umbilical cord complication as a threat, leading to further injury to the mother or her child.
Failing to conduct an emergency c-section procedure in the event of an umbilical cord complication during labor and delivery.
Injuring the mother or her child with forceps and vacuum extractors in the event of an umbilical cord complication during labor and delivery.
Could Have My Child’s Umbilical Cord-Related Birth Injury Been Prevented?
The parents of children who suffered birth injuries often want answers. They want to know what happened that harmed their child. Were there signs of umbilical cord complications – including fetal distress – that the doctors and nurses failed to recognize and/or failed to respond to in a timely manner?
We diligently investigate the facts, including a detailed examination of the fetal heart rate monitoring strips and labor and delivery records. If this review shows the medical providers did not diagnose or respond to fetal distress, we hold responsible parties accountable by pursuing medical malpractice claims against them. The compensation our clients receive helps them pay for their child’s current and future medical treatment, assistive technology and equipment, attendant care, and the other expenses associated with caring for a child with brain injuries, seizure disorders, and cerebral palsy.
Sometimes families are hesitant to reach out to a medical malpractice attorney or law firm. They may feel overwhelmed by their circumstances or are worried that a law firm will not be able to help them. But the only way to find out if you have a case is to talk to an attorney who understands how birth injuries can lead to developmental delays and other birth complications that require long-lasting medical support.
How Long Do You Have To File A Birth Injury Malpractice Lawsuit?
A statute of limitations (SOL) is a law that sets a time limit on how long an injured person has to file a lawsuit after an accident. It is essential to understand that statutes of limitations vary based on the type of case and the state where it is filed. For instance, the deadline for birth injury claims is typically different from other claims, such as injury to personal property, fraud, contract disputes, and collection of debts.
Generally, the clock starts ticking on the date the injury occurred. However, there are exceptions to this rule, and in some cases, the statute of limitations starts when a person discovers or reasonably should have discovered an injury. When dealing with government agencies, SOLs can become even more complex.
For example, if the party that injured you was:
A federal employee
Employed by a military hospital, Veterans Administration facility, or a federally funded medical entity
You may need to file a birth injury claim under the Federal Tort Claims Act (FTCA). In FTCA cases, claimants must go through certain administrative procedures before filing a lawsuit. In some states, if the negligent party was a local or state government hospital or the doctors and medical providers are employees of a governmental entity, the time period in which you must give "notice" may be shorter.
If your case is filed outside of the statute of limitations, it will typically be dismissed, and you will not be eligible to recover compensation for your injuries. Determining when a statute of limitations begins on your case can be tricky. If you're considering pursuing compensation for a birth injury, contacting an attorney as soon as possible is in your best interest.
How Can Our Birth Injury Attorneys Help?
Birth injuries can be prevented in many cases, but it takes a detailed expert review of the facts and circumstances of your pregnancy and your child's birth to determine whether the injury was the result of medical malpractice.
Our Process
At Miller Weisbrod Olesky, a team of committed birth injury attorneys, nurses and paraprofessionals uses our detailed medical negligence case review process to assess your potential birth injury case. We start by learning more about you and your child and the status of meeting/missing developmental milestones. Then we gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused you or your child's injuries.
If we feel medical negligence caused or contributed to complications with your pregnancy or your child's injuries, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors.
At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do. The sooner you reach out to us, the sooner we can begin investigating your case and gathering the evidence needed to support your claim.
We work on a contingency fee basis, meaning you won't pay any legal fees unless we win your case. Contact us today to schedule your free consultation by calling our toll-free line at 888-987-0005 or by filling out our online request form.
