Short Umbilical Cord

A short umbilical cord is a cord shorter than 35 cm at term, and normal length is 50 to 60 cm. It results from reduced fetal movement or limited intrauterine space, and may follow neuromuscular disease, fetal akinesia, skeletal anomaly, oligohydramnios or a chromosomal abnormality. It matters because it can cause slow labour, fetal distress, abruption, cord rupture and uterine inversion.

• Risk factors: oligohydramnios, fetal akinesia, Down syndrome, abdominal wall defects, multiple pregnancy, reduced fetal movement.
• Antenatal diagnosis is unreliable.
• Cord length is measured at birth.

Most women have no symptoms. In labour the signs may be slow descent of the head, fetal heart decelerations as the head descends, abnormal lie or placental abruption.

• Deceleration of the fetal heart with each contraction at descent.
• Fetal movements may be reduced antenatally.
• Differential diagnosis: nuchal cord, cord entanglement, cord compression, cephalopelvic disproportion, abruption, uterine inertia.
• Complications: placental abruption, cord rupture or avulsion, uterine inversion, fetal distress, malpresentation, prolonged labour, caesarean section, neonatal asphyxia.

The diagnosis is made at birth by measuring the cord, and antenatal clues come from scans and tracings.

• Ultrasound: cord seen only as a short length, high fetal position or an abnormal lie; reduced fetal movement; oligohydramnios.
• Cardiotocography with repeated variable decelerations.
• Measure the cord from the fetal abdomen to the placental surface after birth; length below 35 cm confirms the diagnosis.
• Look for fetal anomaly or neuromuscular disease on scan.

The principle is vigilance in labour, avoidance of cord traction, and readiness for emergency delivery and resuscitation.

• Supportive: continuous cardiotocography in labour when suspected; left lateral position; birth in a facility with caesarean section and neonatal care; two cannulae.
• Pharmacological: oxytocin 10 IU IM at birth then infusion of 20 IU in 1 litre sodium chloride 0.9 percent at 125 mL per hour for 4 hours; terbutaline 0.25 mg subcutaneous once to relax the uterus for inversion; glyceryl trinitrate 400 micrograms sublingual for uterine relaxation in inversion; cefazolin 2 g IV before caesarean section or manual replacement; carboprost 250 micrograms IM every 15 minutes (maximum 8 doses) for atony after replacement, avoided in asthma.
• Procedures: controlled cord traction only with the uterus guarded and after a contraction, with traction stopped at any resistance; assisted vaginal delivery or caesarean section for fetal distress; replacement of an inverted uterus by manual pressure on the fundus pushed back through the cervix, or by hydrostatic method with sodium chloride 0.9 percent 2 to 3 litres warmed and infused into the vagina; laparotomy for failed replacement.
• Red flags: slow descent with decelerations, sudden pain with bleeding (abruption), collapse after delivery (inversion), reduced fetal movements.
• Follow-up: newborn examination for anomalies, glucose and haemoglobin if there was bleeding; postnatal review at 1 week and 6 weeks.