Abstract
Since an abnormal umbilical cord such as excessive twisting/torsion, cord compression, coiling at the fetal neck are fetal life threatening or restrict fetal growth, it is diagnosed in detail by real time B-mode ultrasound, color Doppler flow mapping, pulsed Doppler flow velocity wave form, ultrasonic fetal monitor and actocardiogram. Abnormality is evaluated by its location, size, twisting and its pitch of the cord, the grade of variable deceleration (VD), non-invasive stress CTG test in maternal movement, RI and PI, absent or reverse flow of end diastole (ARED) of umbilical arterial blood flow velocity wave form, and particularly pulsating blood flow wave of the umbilical vein related to blood stagnation in the vein and pathological vascular changes of the placental villi, fetal and neonatal blood vessels. Its treatment is maternal position change in mild cord compression, while bed rest and total tocolysis is required when the compression signs are heavy in early pregnancy. The fetus is rescued by cesarean section when threatened fetal life is indicated by signs of severe FHR change or ARED with umbilical vein flow pulsation in spite of eager conservative treatment. CNS damage of the neonate, e.g. periventricular leukomalacia (PVL) and hypoxic-ischemic encephalopathy (HIE), is inspected and treated if necessary after cesarean section.