News Moms Need

Doppler ultrasound is a noninvasive prenatal test that can be used to check a baby’s health in high-risk pregnancies. Providers usually use Doppler ultrasound during the last trimester, but it may be done earlier.

During Doppler ultrasound, your provider or ultrasound technician holds a plastic tool, called a transducer, against your skin to measure the blood flow in the umbilical cord and some of your baby’s blood vessels. (Regular ultrasound will show you a still image, but it cannot show the actual blood flow.) High-frequency sound waves are bounced off circulating red blood cells to project the image of the flow. This test shows if your baby is getting enough oxygen. Your provider also can listen to your baby’s heartbeat using Doppler ultrasound.

Some providers use Doppler ultrasound to check mothers with Rh disease.  This is a condition where a difference between the mother’s blood and baby’s blood can cause a dangerous kind of anemia in the baby. Anemia is when the body doesn’t have enough red blood cells or the red blood cells are too small. When the condition is found early and treated, most affected babies survive. Doppler ultrasound has reduced the need for amniocentesis to monitor fetuses at risk of Rh disease.

Many new moms and dads are nervous about caring for their baby’s umbilical cord stump. It’s not difficult, but you need to pay attention to make sure it doesn’t get infected.

Your baby’s umbilical cord stump will drop off at about 10 days after birth. Until then, keep it clean and dry.
• Tuck the diaper below the cord so that the cord is exposed to the air.
• Be sure the area around the cord is clean and dry. If it gets dirty, clean the area with a baby wipe. Or dip a cotton swab in rubbing alcohol, and gently clean around the cord.
• Call your baby’s provider if you see pus or redness or if he cries when you touch the area. These could be signs of infection.
To learn how to give your baby a sponge bath until his belly button heals, read Bathing Your Baby.

About 1 percent of singleton and about 5 percent of multiple pregnancies (twins, triplets or more) have an umbilical cord that contains only two blood vessels, instead of the normal three. The cause of this abnormality, called single umbilical artery, is unknown.

The umbilical cord is the life-line that attaches the mother and developing baby. Connecting through the placenta, a normal umbilical cord is made up of three blood vessels. One large vein carries oxygen and nutrient-rich blood to the baby and the two smaller arteries carry blood and waste products back to the placenta. The umbilical cord normally grows to about two feet in length, allowing the baby enough cord to safely move around without causing damage to the cord or the placenta.

In a single umbilical artery, one artery is missing. Studies suggest that babies with single umbilical artery have an increased risk for birth defects, including heart, central nervous system and urinary-tract defects and chromosomal abnormalities. A woman whose baby is diagnosed with single umbilical artery during a routine ultrasound may be offered certain prenatal tests to diagnose or rule out birth defects. These tests may include a detailed ultrasound, amniocentesis (to check for chromosomal abnormalities) and in some cases, echocardiography (a special type of ultrasound to evaluate the fetal heart). The provider also may recommend that the baby have an ultrasound after birth. 

The diagnosis of a single umbilical artery does not necessarily mean that the baby will have a birth defect. It does mean, however, that some tests are warranted and that closer attention needs to be paid for the remainder of the pregnancy.

Sometimes the umbilical cord may become wrapped around a part of a developing baby’s body. This is most often found around the baby’s neck and happens when the baby moves through a loop of the cord. Less frequently, the umbilical cord becomes wrapped around other body parts, such as a foot or hand. Generally, this doesn’t harm babies and they are born healthy.

Believe it or not, this happens more often than you might think. One loop around the neck occurs in approximately 20% of pregnancies, while multiple loops occur in 5% of cases. Again, most of the time, everything is fine.

Sometimes, though, fetal monitoring shows heart rate abnormalities during labor and delivery in babies with a nuchal cord. This may be as a result of pressure on the cord.  Doppler ultrasound usually can detect any nuchal loops. Even then, the pressure is rarely serious enough to cause death or any lasting problems. A nuchal loop alone is not a reason to change a woman’s birth plan. Occasionally, a cesarean delivery may be needed if multiple loops are involved or the baby’s heart rate appears to be seriously effected.

A recent study suggests that it might be best for docs to wait a minute or two before clamping the umbilical cord after a baby is born.  It’s important to cut off the blood flow from Mom to baby at some point, especially before there is an opportunity for the flow to reverse itself. But waiting an extra 60 seconds or so might provide Junior with extra stem cells within the cord blood.  Stem cells are powerful and can grow into different types of cells the body needs.

According to Dr. Paul Sandberh, author of the study published in a recent issue of the Journal of Cellular and Molecular Medicine, different studies on preterm infants have found postponing clamping the cord for 30 seconds or more reduced the incidence of anemia, intraventricular hemorrhage (brain bleeding), late-onset sepsis (a complication of infection in the days after birth), and decreased the need for blood transfusions. It may help prevent anemia in full-term infants. He refers to delayed clamping as “nature’s first stem cell transplant” – an intriguing thought.

You probably have read pros and cons of storing a baby’s cord blood. The American Academy of Pediatrics thinks it is unwise to store cord blood in a private blood bank, unless your family has a history of a certain disease. The AAP and many scientists favor the collection and storage of cord blood in public banks so someone may have the opportunity of using stem cells in the future.  This recent study asks the question will delaying clamping the cord after birth provide a cord blood boost to babies now?

Dr. Sandberh believes that more needs to be learned about the timing of clamping off the flow of cord blood, and it’s worth investigating.  If you’re pregnant, you might want to have a conversation with your provider about when to clamp the cord when your little one arrives.

The placenta is a remarkable organ that connects the mother’s blood supply with that of the developing fetus through the umbilical cord.  It transports oxygen and nutrients to the baby’s blood and returns the baby’s waste to the mom’s blood for disposal through her kidneys.

The placenta, formed from the same cells as the embryo, attaches to the wall of the uterus and to the umbilical cord. Oxygen-rich, nutritious blood travels from Mom to the fetus by the umbilical vein in the umbilical cord.  The umbilical vein delivers the blood to the liver and then much of it travels on to the right side of the heart. Here it mixes with blood of the fetus and is sent on through two special openings, bypassing the nonfunctioning lungs, into the left side of the heart for distribution to the entire body.  After completing the circuit, the blood that has delivered oxygen and nutrients to the fetus now flows via major vessels back to the umbilical cord where the two umbilical cord arteries carry it back to the placenta.

While the placenta allows oxygen and nutrients to pass through it, it also filters out many potentially harmful substances and infections. Near term, the placenta produces hormones that play a role in triggering labor and delivery.  After the baby is born, the placenta’s job is done and the placenta is delivered as the afterbirth.

In some cases the placenta may not develop correctly or function as well as it should. It may be too thin, too thick or have an extra lobe, or the membranes may be improperly attached.  Most of these issues are detected via ultrasound.  Signs of a problem include vaginal bleeding and/or continuous abdominal pain.  If you’re pregnant and have questions about your placenta, ask your doctor about it during an ultrasound.