Can placenta previa with the umbilical cord wrapped around the neck one time be delivered vaginally?

Written by Zhang Lu
Obstetrics
Updated on November 23, 2024
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Placenta previa and umbilical cord around the neck are two relatively common clinical conditions during pregnancy, and they have different impacts on natural childbirth. First, having the umbilical cord wrapped around the neck once is a very normal physiological occurrence, and it generally does not affect the ability to have a natural childbirth in any situation. Therefore, from the perspective of the umbilical cord around the neck, it does not affect natural childbirth. Second, placenta previa refers to the lower edge of the placenta being close to the internal os of the cervix. Whether natural childbirth is possible mainly depends on the type of placenta previa. If it is a partial or central placenta previa, such conditions generally cannot proceed with natural childbirth, as they might cause significant bleeding, necessitating an elective cesarean section. However, in the case of marginal placenta previa, where there is still some distance between the lower edge of the placenta and the cervical os, attempting natural childbirth might be possible, provided that preparations for a cesarean section are in place.

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Written by Du Rui Xia
Obstetrics
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Can umbilical cord around the neck perform fetal position correction?

In cases of nuchal cord, it is not advisable to attempt correcting abnormal fetal positions, because if the fetal position changes abnormally after an attempted correction while the umbilical cord is wrapped around the neck, it may worsen the degree of the nuchal cord, potentially leading to fetal hypoxia or even asphyxiation. However, if the umbilical cord is relatively long, it might not affect the changes in fetal position, and sometimes the fetus can automatically free itself from the nuchal cord through its own movements. It is important to regularly visit the hospital for prenatal check-ups to detect any other potential abnormalities.

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Written by Zhang Lu
Obstetrics
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What should I do if the fetal umbilical cord is wrapped around the neck once?

During the prenatal ultrasound, it is sometimes discovered that the umbilical cord is wrapped around the fetus's neck, which concerns many pregnant women who fear it may cause fetal hypoxia in utero or affect natural childbirth. However, this concern is not accurate. Currently, in clinical practice, an umbilical cord around the neck is considered a normal physiological phenomenon. Around 30%-40% of fetuses may have the umbilical cord wrapped around their neck. It is acceptable for the umbilical cord to be wrapped around the neck once or twice, as this neither impacts the fetus's oxygen levels nor affects the mode of childbirth; natural birth can still be considered. Therefore, when the umbilical cord is wrapped around the neck once, no intervention is required. Follow the normal prenatal check-up routine and pay attention to fetal movements in daily life. As long as the fetal movements are normal, it indicates that the fetal condition in the uterus is good.

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Written by Zhang Lu
Obstetrics
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Is it dangerous for the umbilical cord to be wrapped around the neck during the mid-stage of pregnancy?

During a mid-pregnancy ultrasound, it is sometimes indicated by the presence of a U-shaped or W-shaped notch behind the fetus's neck that the fetus may have the umbilical cord wrapped around its neck. During pregnancy, it is perfectly normal for the umbilical cord to wrap around the neck, and it generally does not affect the fetus or pose any danger. The length of the umbilical cord during pregnancy is approximately 30 to 80 centimeters, which is quite long relative to the size of the uterine cavity. Hence, many umbilical cords have excess length that can wrap around the neck or limbs of the fetus, leading to the umbilical cord being coiled around the neck or limbs. However, current research indicates that whether the umbilical cord is wrapped around the neck or limbs once or twice, it does not affect the fetus. It does not cause intrauterine hypoxia or affect the growth and development of the fetus, nor does it influence the mode of delivery. A natural childbirth can still be an entirely viable option.

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Written by Du Rui Xia
Obstetrics
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The difference between U-shaped and W-shaped nuchal cords.

During pregnancy, through ultrasound examination, if echoes of the umbilical cord are found around the fetus’s neck in U-shaped or W-shaped patterns, this indicates the presence of nuchal cord. The difference between U-shape and W-shape primarily lies in the number of wraps around the neck. A U-shaped notch indicates the umbilical cord is wrapped around the neck once; a W-shape indicates it is wrapped twice. When nuchal cord is present, there is no need to be overly anxious; regular prenatal check-ups can be conducted at the hospital to monitor the development of the nuchal cord and the safety of the fetus inside the uterus.

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Written by Du Rui Xia
Obstetrics
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How to count fetal movements when the umbilical cord is wrapped around the neck

When there is nuchal cord presence, it is important to determine the number of loops around the neck as well as the tightness of the loops, to assess if they might affect the fetal heart rate. Generally, nuchal cords do not impact fetal blood circulation, so fetal movement can still be measured normally. Proper measurement should be taken at fixed times each day: morning, noon, and evening—for example, at 7 AM, 12 PM, and 9 PM respectively. During each of these times, select one hour when you can calmly and attentively feel and count the baby’s movements in a quiet setting, and record the number of movements.