The Umbilical Cord (UC) is the nexus between the placenta and the baby. Since the placenta is in intimate contact with the mother, it is then the indirect link between the baby and its mother. It must be remembered that the placenta belongs to the baby and not to the mother and that its function is to provide an instrument for the exchange between mother and fetus, maintaining a protective barrier between the two. By moving away from the placenta, but attached to it by the cord, the baby has complete freedom of movement allowing the proper development of all the organs of his body. In rare cases where it is exceedingly short, the baby suffers severe deformities

The Umbilical Cord is a tubular structure of about 50 cm. of average length that is formed by two (2) arteries that leave the baby go to the placenta and one (1) vein that originates in the placenta goes back to the baby, all this surrounded by a kind of firm gelatin (Gelatin of Wharton) covered by a thin wrapper. When we talk about arteries and veins, we infer that UC is a vascular component that allows blood flow between the baby and its placenta.

The cord has a simple but very specialized structure, the two arteries that are part of it have their origin in two important arteries of the baby (iliac arteries) and therefore have their own heart because they are in direct relationship with the fetal heart. The umbilical vein is generated from the fusion of many placental veins of smaller caliber to form a single conduit that leaves the placenta is directed towards the baby maintaining a continuous flow without beats since the intraplacental pressure and the suction effect of the circulatory system of the baby make the blood go towards him.

The heart of the baby is the motor that drives the fetal blood, low in oxygen and full of impurities, to the two umbilical arteries in order to take it to the placenta so that through an exchange at a distance with the mother, the placenta can oxygenate it and clean it in a matter of milliseconds. Intraplacental pressure, hydrostatic phenomena and fetal circulatory effects generate enough pressure for the “renewed” blood to be conducted back to the baby.

Wharton’s gelatin and its wrap give the UC stiffness and elasticity so that it does not bend or compress with the movements of the baby. Likewise, its length allows the fetus to move freely without compromising its circulation.

What is the function of the UC

The fetus does not “breathe” and is never hungry inside the womb. Although we see him with “breathing movements” and swallowing inside the womb (by Eco) he is only exercising certain very important functions, but without nutritional value. Everything the baby needs comes from the mother in the form of oxygen and nutrients found in the mother’s blood to be filtered by the placenta and derived to the baby through the umbilical cord.

The baby depends on the Cord to live and develop until ready to be born, if for some reason the circulation of the cord is suddenly obstructed the fetus will die in a matter of 3 to 5 minutes.

Medical importance of UC

The UC can be studied by ultrasound. The first thing that must be done is to determine the presence of its 3 vascular components, because when there is an umbilical artery missing (less than 1% of babies) very frequently (30%) there are other associated fetal anomalies. Once this is revised, we can evaluate the approximate length of the cord, qualitatively see the length of the observed trajectories and their mobility, if there are cord circles around the fetal neck and if they are loose or tight.

The study with more prognostic character that we can do in the CU is the Doppler Study or the study of blood flow through the cord. Through the Doppler study we can indirectly evaluate the oxygenation of the baby and the conditions of its “internal environment” (eg blood acidity) to separate healthy babies from those babies compromised by fetal diseases or maternal diseases that affect the fetus (eg, preeclampsia ).

Recently the cord has received a lot of attention from the curative point of view: there are American and some Latin American companies that collect their blood (Cord Blood Banks) at birth to obtain fetal pluripotent cells that would allow obtaining 100% compatible cellular systems for the treatment of many severe diseases. This is a very promising future and a guarantee for the future of a baby’s life. In short, I would avoid the viacrucis that is required to obtain a cell donor compatible with the affected patient.

Perhaps in the future, complete organs (kidneys, liver) could be obtained for a 100% compatible transplant through the use of genetic engineering techniques.

Particular Situations

Cord Loops: is the presence of one or more “cord turns around the baby’s neck before or at the time of birth. Many mothers worry because they have been told that their baby has a circular, the fact is that these appear and disappear due to the movements of the baby. It does not imply the realization of a caesarean or complication for babies, approximately 20% will have a circular cord at birth, and will have no problem in the vast majority of cases.

True Cord Knot: due to its movements, the baby can tie its cord. Usually no problem occurs but if it were to tighten it could endanger the baby’s life. If diagnosed during pregnancy, many obstetricians would decide to perform a cesarean section instead of allowing a vaginal delivery.

Short Cord: very short cords (less than 30 cm) can present complications at the time of delivery: prolongation of labor, placental detachment, cord rupture and fetal hemorrhage. Quite uncommon

What happens when we cut  the UC at delivery:

When the baby is born and the cord is cut, the newborn becomes an independent being, will have to begin to breathe, feed and fulfill metabolic functions on its own. He becomes a helpless being that requires all the care and external attention of his mother to survive during its first months and years