These are knots that form in the baby’s umbilical cord, occurring in 1 out of 2,000 pregnancies. They happen most often in identical twins sharing the same amniotic sac. They can also occur when babies flip and turn in the womb. Because cord vessels compress when a knot tightens, these knots are especially dangerous, increasing the chances of fetal death and brain injury from HIE significantly. Knots are detectable via ultrasound, however, and it is standard procedure to test for knots prenatally when certain risk factors exist. Failing to do so is medical negligence. Due to the high risks posed by these knots, it is common to admit the mother to the hospital for close monitoring to prevent sudden fetal distress. C-sections are often necessary in these cases.
When a baby is in the womb, the umbilical cord transports nutrient and oxygen rich blood to the baby from the mother and placenta. If the umbilical cord becomes impinged upon / occluded and there is a decrease in the flow of blood, the baby can be deprived of oxygen and nutrients. A lack of oxygen to the baby’s brain can cause permanent brain injury, such as hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Longer term umbilical cord problems can cause the baby to have intrauterine growth restriction (IUGR / small size) and brain damage.
There are many different types of umbilical cord problems that can endanger a baby. A nuchal cord is when the cord is wrapped around the baby’s neck, and a prolapsed umbilical cord is when the cord travels in front of the baby as the baby exits the birth canal. Both of these conditions can cause the cord to be impinged upon, thereby reducing the flow of blood to the baby. A nuchal cord can also cause the neck blood vessels to be constricted and congestion of the blood, both of which can deprive the brain of oxygen-rich blood.