When baby is all looped up in the womb

Georgina* was staring at me unamused. She has had three babies delivered normally and here she was, due to deliver her fourth, and baby was not cooperating. She had to undergo a caesarian section. Her little one adamantly sat there in the womb, in breech presentation, her bottoms coming first instead of the head. 

Georgina had bargained with the baby for the past three weeks but here she was, almost 39 weeks,  and baby steadfastly remained in breech presentation. Generally, if the baby is still in breech presentation past 35 weeks of gestation, it is highly unlikely to turn. This wasn’t a possibility Georgina relished. She held long conversations with her unborn baby, ranging from firm instruction to bargaining to literally pleading, all to no avail.  This was her final visit and she felt dejected. She had to face up to the reality of going under the knife. We walked through the details of surgery one more time, the actual surgery, expectations, outcomes, possible risks and complications. She left with the necessary paperwork, ready for admission to the hospital in a few days’ time. 

On the morning of surgery, Geogina was accompanied by her husband and her mum. She was surprisingly calm, having accepted the inevitable. This was further reinforced by the prayer from her mum just before she was wheeled away to the operating room. 

Surgery commenced smoothly and within minutes, baby was extracted from the womb, feet first. Georgina, who was conscious through the surgery, under spinal anaesthesia, was overwhelmed with tears of joy, hearing her newborn daughter wailing lustily a few minutes after six o’clock on a Saturday morning! She shared a birthday with her mum! 

The healthy baby was accompanied by some interesting findings. The umbilical cord was looped round her neck twice, a fairly common finding, but was also looped round her left shoulder and out under the right arm. In addition, it had a perfectly looped knot, what is medically termed as a true knot! The entire length of the umbilical cord measured 137cm! 

Georgina’s baby had what is medically termed as umbilical cord entanglement. This may occur more commonly as a loop or umbilical cord round the baby’s neck, or less commonly as loops round other body parts such as abdomen and limbs.

I was reminded of Georgina’s baby when my senior, Prof Omondi Ogutu, delivered one of his patients with the baby looking like he was caught up in a spider web of his own umbilical cord! The baby was all tangled up in loops of cord round the neck, lacing over the shoulders and coiling round the body. The newborn looked ready to bungee jump!

It was a miracle the little one survived the harrowing trip into this world. This was no easy caesarian section. He lay there calming blinking, unaware of the furore he had raised in the operating room and beyond. We were all in awe!

A normal umbilical cord measures approximately 50cm to 60cm in length. Anything longer than 100cm is regarded as abnormal.

Though in most babies this may not be an issue, problems arise when the excessively long cord gives the baby too much leeway to loop all around it throughout the nine months in the womb. This is even worse when the baby also has excessive amniotic fluid.

These loops may get unreasonably tight, impeding normal labour and delivery. The baby is then at risk of distress, birth asphyxia and even perinatal death. In even rarer occasions, the baby may end up with sudden death in the womb due to true knots getting too tight and cutting off blood circulation from the placenta to the unborn baby.

On the other hand, babies may be born with an abnormally short cord, less than 20cm in length. These babies have an increased risk of perinatal death. Birth asphyxia occurs when the foetus does not get adequate oxygen during labour. 

Different cultures hold different beliefs regarding this lifeline that remains the conduit of life from mother to baby for weeks before delivery. A healthy umbilical cord is therefore paramount in a baby’s well-being. A supple cord with three blood vessels in it with a healthy layer of Wharton’s jelly to insulate them is the dream of every obstetrician or midwife! On average it should be at least 12mm in diameter to ensure adequate blood flow and protection from compression.

Today, we spare a thought for all those angels who inadvertently strangled themselves to death.

Dr Bosire is an obstetrician/gynaecologist