A nuchal cord (umbilical cord looped around the neck of the foetus), often only causes problems during the delivery phase. As the foetus engages deeper, the umbilical cord loop can become tightly drawn around the neck. As a result, partial or complete obstruction of the veins can arise during the contraction, and subsequently of the umbilical artery as well.
During the contraction, a short acceleration of the foetal heart rate occurs, which is immediately followed by marked bradycardia that acutely recovers at the end of the contraction.
Procedure 1
- Once the head has been born, the neck should be palpated for evidence of a nuchal cord.
- Grasp the umbilical cord with one or two fingers, and gradually pull it to create a large loop.
- If it is easy to create a large loop, slide the umbilical cord off over the head and allow the child to be delivered further.
- Continue with the delivery of the child if the umbilical cord can be slackened easily, but not far enough to be slipped over the head. If the umbilical cord is very tight around the neck and stagnation occurs, clamp the umbilical cord using Kocher clamps.
Procedure 2
- Hook two fingers behind the umbilical cord.
- Place two Kocher clamps between the fingers, several centimetres apart on the umbilical cord.
- Cut through the umbilical cord between the clamps protected by the examining fingers.
- Unwind the umbilical cord from the neck.
- Deliver the child as normal.