A nuchal cord occurs when the umbilical cord becomes wrapped around the fetal neck 360 degrees.
There are two types:
- A “Type A” nuchal cord is wrapped around the neck 360 degrees.
- A “Type B” pattern is described as a hitch which cannot be undone and ends up as a true knot
Goal: To protect umbilical circulation whenever possible. Techniques to preserve an intact nuchal cord depend on how tightly the cord is wrapped around the infant’s neck.
- If the cord is loose, it can easily be slipped over the infant’s head. The infant can be delivered normally and placed on maternal abdomen as desired.
- If the cord is too tight to go over the infant’s head, the provider may be able to slip it over the infant’s shoulders and deliver the body through the cord. The cord can then be unwrapped from around the baby after birth.
- If the cord is too tight to slip back over the shoulders, one may use the somersault maneuver to allow the body to be delivered.
- The birth attendant may also choose to clamp and cut the umbilical cord to allow for vaginal delivery if other methods of nuchal cord management are not feasible.
“Coils occur in about 25% of cases and ordinarily do no harm, but occasionally they may be so tight that constriction of the umbilical vessels and consequent hypoxia result.” Williams Obstetrics 16th Edition