• The placenta receives deoxygenated blood from the umbilical cord, which carries back oxygenated blood to the baby and nutrient-poor blood from the baby to the placenta. (srbhawaiilaw.com)
  • If women have risk factors for placenta accreta, doctors do ultrasonography periodically during the pregnancy to check for this complication. (msdmanuals.com)
  • When the cord gets tangled or compressed, grows too much or not enough, or connects poorly to the placenta, known as velamentous insertion, allowing this condition to go undetected or unaddressed may result in catastrophic harm in the form of a birth injury . (fronzutolaw.com)
  • The umbilical cord is essentially the womb's jelly-wrapped lifeline, connecting the fetus at the stomach to its mother by the placenta. (fronzutolaw.com)
  • The umbilical cord connects the baby to the placenta in the mother's womb, transporting oxygen and nutrients to the baby, and carrying away waste products, such as carbon dioxide. (matzuslaw.com)
  • Running from the baby's abdomen to the placenta, the umbilical chord usually contains three blood vessels It provides oxygen, blood, and nutrients to the developing foetus. (imumz.com)
  • When the mum is having contractions, it means that the uterus is 'shrinking' down (contracting) moving the baby downwards, along with their attached placenta and chord. (imumz.com)
  • [ 16 ] The incidence can be overestimated with gross examination of the cord, especially if the portion close to the placenta is examined, because the arteries may fuse close to the placenta. (medscape.com)
  • In general, birth injuries can happen when an umbilical cord does not grow enough or grows too much, when it is not properly connected to the placenta, when it gets knotted, or when it gets squeezed. (chicagomalpracticeteam.com)
  • Potentially umbilical cord problems and conditions include the umbilical cord being too short or too long, not connecting properly to the placenta, or becoming knotted or compressed. (wkw.com)
  • Vasa previa occurs when one or more of the blood vessels from the umbilical cord or placenta cross the cervix. (wkw.com)
  • This means that the vessels are not protected by the Wharton's jelly in the umbilical cord or the tissue in the placenta. (wkw.com)
  • You may also be at risk if your baby's umbilical cord doesn't connect properly to the placenta, or if you have other placenta problems like placenta previa. (wkw.com)
  • It is also more prevalent with long umbilical cords, polyhydramnios (excess amniotic fluid), manually ruptured membranes, and multiple births. (fronzutolaw.com)
  • We detected amniotic fluid with meconium in 506 (13.1%) patients with a nuchal cord and 270 (1.3%) without a nuchal cord, and the difference was found to be significant. (dergipark.org.tr)
  • Conclusions: There is no significant relationship between vaginal deliveries with the nuchal cord and poor perinatal outcomes, except for meconium amniotic fluid. (dergipark.org.tr)
  • Otherwise, a nuchal chord may be misdiagnosed as foetal skin folds, amniotic fluid pockets, posterior cystic neck mass, or even a chord that is simply near the foetal neck but not encircling it. (imumz.com)
  • Through this research, we aim to analyze the prevalence of nuchal cord in various birth settings and its association with neonatal health and delivery complications. (prenatal.or.id)
  • The prevalence of nuchal cord is about 10%-29% of fetuses and increases with increasing gestational age [ 9 ]. (e-cep.org)
  • citation needed] Ultrasound diagnosis of a cord around the neck was first described in 1982. (wikipedia.org)
  • There are currently three recent texts on ultrasonography which demonstrate the ability of ultrasound to identify umbilical cord issues with reliability as of 2009. (wikipedia.org)
  • citation needed] A study published in 2004 was done to establish the sensitivity of ultrasound in the diagnosis of a nuchal cord. (wikipedia.org)
  • Only 18 of the 52 cords or 35% of the nuchal cords were detected on ultrasound done immediately before delivery, and 65% of nuchal cords were not detected. (wikipedia.org)
  • Of the 237 cases where there was no cord at delivery, ultrasound had false positive results, i.e. diagnosed a cord in 44 of the 237 cases (19%) in which there was no cord present at all. (wikipedia.org)
  • In this study, ultrasound was only 35% accurate at finding a single loop, and only 60% accurate at detecting a nuchal cord wrapped multiple times around the neck. (wikipedia.org)
  • In no study was it possible by ultrasound to distinguish between a loose or a tight cord, although at least 3 attempted to do so. (wikipedia.org)
  • citation needed] Peregrine concludes that ultrasound diagnosis of nuchal cords will only be useful if doctors are able to do so reliably and predict which of those fetuses are likely to have a problem. (wikipedia.org)
  • Ultrasound measurement of the velocity of flow in the cord may be useful in the management of twins and chronically growth-retarded fetuses. (wikipedia.org)
  • To date there are no ultrasound courses which teach the identification of nuchal cord to physicians or technicians. (wikipedia.org)
  • As such, conditions affecting the umbilical cord may be detected through ultrasound during pregnancy and must be planned for appropriately to prevent severe complications. (fronzutolaw.com)
  • In a case where the doctor has any concern that the umbilical cord might be entangled,the standard practice is to take an ultrasound. (matzuslaw.com)
  • 13. Peregrine E, O'Brien P, Jauniaux E. Ultrasound detection of nuchal cord prior to labor induction and the risk of Cesarean section. (dergipark.org.tr)
  • To see a nuchal chord, your doctor will take many ultrasound images from multiple angles. (imumz.com)
  • Any of these serious types of umbilical cord conditions should be properly identified by a healthcare provider through an ultrasound and should be treated to avoid further complications or harm to your baby. (chicagomalpracticeteam.com)
  • Your doctor should be able to detect this on an ultrasound and slip the cord off the baby's neck during labor and birth. (wkw.com)
  • This phenomenon increases the risk of fetal distress and is usually associated with a long umbilical cord [ 8 ]. (e-cep.org)
  • We examined the relation between the length of the umbilical cord and perinatal outcomes in Japanese singleton pregnancies delivered at ≥ 34 weeks' gestation. (jcgo.org)
  • The short or long umbilical cords may not be associated with the adverse perinatal outcomes in Japanese singleton pregnancies delivered at ≥ 34 weeks' gestation. (jcgo.org)
  • Another cord condition, known as single umbilical artery, occurs more commonly in multiple rather than singular pregnancies. (fronzutolaw.com)
  • Approximately 15-35% of pregnancies involve a nuchal cord. (matzuslaw.com)
  • 12. Gonzalez-Quintero VH, Tolaymat L, Muller AC, Izquierdo L, O'Sullivan MJ, Martin D. Outcomes of pregnancies with sonographically detected nuchal cords remote from delivery. (dergipark.org.tr)
  • Problems with umbilical cords are actually a common part of pregnancies, many of which cause no health concerns for the baby. (latonalaw.com)
  • While nuchal cords are common, they occur more frequently in pregnancies with multiple babies or when the cord is especially long. (latonalaw.com)
  • As the March of Dimes explains further, an umbilical cord will begin to form during the fourth week or pregnancy or thereabouts, and it will ultimately grow to be approximately 22 inches long in normal pregnancies. (chicagomalpracticeteam.com)
  • Problems with the umbilical cord are common among many pregnancies and deliveries. (birthinjurylawyer.com)
  • The placental end of the chord goes under the umbilical end of the chord, potentially leading to another type of umbilical chord complication known as a "true knot. (imumz.com)
  • Short cords are associated with reduced fetal movement or intrauterine constraint, as well as placental abruption, cord rupture, and emergent cesarean deliveries (ECDs) for nonreassuring fetal heart rate (NRFHR). (medscape.com)
  • In cases of placental abruption , oligohydramnios , or breech presentation , consideration may be given to measurement and documentation of cord length after birth, because an abnormal cord length argues for a long-term fetal condition. (medscape.com)
  • It is possible for the umbilical cord to get wrapped around the baby's neck and prevent the necessary blood flow and oxygen to the baby. (matzuslaw.com)
  • This occurs when the cord is wrapped around the baby's neck. (matzuslaw.com)
  • When the umbilical cord is wrapped around the baby's neck it can be very dangerous because it can literally strangle the baby. (matzuslaw.com)
  • Also, even if the cord isn't wrapped around the baby's neck, it can become compressed against itself or against the baby's neck, and this too can restrict or limit normal oxygen delivery to the baby. (matzuslaw.com)
  • Nuchal cord, also called nuchal loops, is when the umbilical cord is wrapped around the baby's neck or other parts of the body (such as a foot or hand). (wkw.com)
  • A nuchal cord occurs in about one fourth of deliveries. (merckmanuals.com)
  • Objectives: To investigate the frequency of cord entanglement and neonatal outcomes in vaginal deliveries. (dergipark.org.tr)
  • 8. Schaffer L, Burkhardt T, Zimmermann R, Kurmanavicius J. Nuchal Cords in term and Postterm Deliveries- do we need to know? (dergipark.org.tr)
  • Reports tell us that almost 20 to 30 percent of all deliveries involve a nuchal cord. (imumz.com)
  • The umbilical cord complications of true knots, nuchal coils, and cords around the body. (dergipark.org.tr)
  • This substance helps to protect the cord against compression as well as true knots as a result of the baby's normal movements. (imumz.com)
  • Excessively long cords are associated with fetal entanglement, true knots, and thrombi. (medscape.com)
  • If you believe medical malpractice caused your child's nuchal cord injury, seek legal advice immediately with an experienced Hawaii nuchal cord injury attorney. (srbhawaiilaw.com)
  • But, when medical malpractice is a cause of childbirth complications, or injuries sustained through the improper handling of complications, the child and the child's family may be entitled to compensation through the institution of legal action against the responsible parties. (thebirthinjuryfirm.com)
  • Negligent management of the breech presentation of a fetus, one of the most common childbirth complications, may also result in liability of medical personnel assisting in a child's birth. (thebirthinjuryfirm.com)
  • A problem with the umbilical cord could pose a serious threat to your health and your child's well-being. (fronzutolaw.com)
  • Unfortunately, parents may not be aware of some complications when they arise and will only be able to fully evaluate the child's health and development after birth, and sometimes years later. (gilmanbedigian.com)
  • One condition requiring emergency preparation is umbilical cord prolapse, which occurs when the umbilical cord enters the vaginal canal before the baby does, pinching off the cord and thus restricting oxygen flow to the baby. (fronzutolaw.com)
  • Umbilical cord prolapse may represent a serious problem if oxygen restriction occurs and is severe enough to cause brain damage or fetal death (still birth) if the baby is not delivered immediately. (fronzutolaw.com)
  • Doctors can detect cord prolapse by the baby's heart rate and a pelvic exam, thereby locating the umbilical cord in the birth canal. (fronzutolaw.com)
  • In an umbilical cord prolapse, the umbilical cord slips ahead of the fetus and moves into the cervical canal, vagina, or comes out of the birth canal before the baby. (matzuslaw.com)
  • In a cord prolapse case, an emergency cesarean section is often necessary. (matzuslaw.com)
  • This condition, known as umbilical cord prolapse, is a common cause of umbilical cord compression. (latonalaw.com)
  • Prolapse is when the umbilical cord enters the birth canal before the baby has been delivered. (birthinjurylawyer.com)
  • Umbilical cord prolapse occurs when there is pressure put on the umbilical cord and it becomes compressed. (wkw.com)
  • There are several types of umbilical cord conditions, and each come with their own set of complications. (wkw.com)
  • A "tight" nuchal chord is defined as one that cannot be slipped over the baby's head during delivery, and may compress the fetal neck. (imumz.com)
  • Nuchal cord is defined as the umbilical cord being wound around the fetal neck [ 7 ]. (e-cep.org)
  • citation needed] To date, there is no prospective case control double-blind study looking at nuchal cords and observational studies vary in opinion as to the degree of poor outcomes. (wikipedia.org)
  • Studies have shown an improvement in outcomes where cord entanglement was prenatally identified in these cases. (wikipedia.org)
  • The characteristics and perinatal outcomes of groups with and without nuchal cord were compared. (dergipark.org.tr)
  • The purpose of this study is to investigate the incidence of nuchal cord occurrences and their potential impact on neonatal and delivery outcomes. (prenatal.or.id)
  • Both increased or decreased umbilical cord coiling has been associated with abnormal outcomes. (medscape.com)
  • In fact, in terms of outcomes for mothers & babies, studies show that planned home birth has perinatal mortality levels (the numbers of babies dying around the time of birth) at least as good as - and often better than - hospital figures, with lower rates of complications and interventions . (thehealthyskeptic.org)
  • Outcomes of trial of labour of nuchal cord. (pakmedinet.com)
  • Symptoms present in the baby shortly after birth from a prior nuchal cord may include duskiness of face, facial petechia, and bleeding in the whites of the eye. (wikipedia.org)
  • Before birth, a nuchal cord can sometimes be detected by ultrasonography, but no action is required. (merckmanuals.com)
  • It is beneficial to clearly understand what nuchal cord birth injury is and what actions you can take. (srbhawaiilaw.com)
  • It is absolutely horrifying for expecting parents to learn that their child suffered a nuchal cord injury at birth. (srbhawaiilaw.com)
  • In particular, if the birth injury and complications resulted from medical negligence and malpractice. (srbhawaiilaw.com)
  • Our credible birth injury lawyer works with nuchal cord injury cases. (srbhawaiilaw.com)
  • Brain damage is one of the most severe complications from nuchal cord birth injuries. (srbhawaiilaw.com)
  • Mistakes from medical professionals can cause birth injuries and lifelong complications for a child. (abclawcenters.com)
  • If your child has suffered a childbirth complication injury or has died as a result of childbirth complications due to medical malpractice or negligence, contact experienced birth injury and childbirth complication attorney Jeffrey Killino at 877-412-8490 for a free evaluation of your case. (thebirthinjuryfirm.com)
  • An obstetrician or other medical professional assisting in the birth of a child may also cause childbirth complication injuries or enhance injuries due to such complications through negligent care during the labor and delivery stages of childbirth. (thebirthinjuryfirm.com)
  • The failure of an obstetrician or other medical professional assisting in the birth of a child to properly monitor and respond to fetal or maternal distress, for example, may be found to constitute a cause of a childbirth complication injury . (thebirthinjuryfirm.com)
  • If you or your child was injured due to a doctor or hospital's negligence handling umbilical cord problems in New Jersey, you may wish to discuss your case with an experienced birth injury attorney who can investigate the circumstances and advise you of your rights. (fronzutolaw.com)
  • When its job is complete, the umbilical cord is cut at delivery, either immediately or soon after birth upon the mother and baby's initial bonding. (fronzutolaw.com)
  • Still attached to the baby's abdomen at birth, the umbilical cord is 0.5 to 0.75 inches in diameter, and approximately 20 inches long. (matzuslaw.com)
  • Here are three complications that can lead to brain injury to a fetus before or during birth. (headleyfirm.com)
  • Here is what you need to know - nuchal cords are surprisingly common and unlikely to cause problems during pregnancy or at birth. (imumz.com)
  • Be assured: nuchal chords are surprisingly common and unlikely to cause problems during pregnancy or at birth. (imumz.com)
  • Umbilical cord knots can result in hypoxic-ischemic encephalopathy and other birth injuries. (latonalaw.com)
  • General surgeons are often sued for failure to anticipate birth complications due to the fetal size, failure to catch a nuchal cord, failure to perform a C-section, or improper use of forceps or a vacuum extractor, all of which can cause iatrogenic injuries. (cronuslaw.com)
  • Yet certain umbilical cord conditions and complications can result in severe birth injuries, including debilitating defects and stillbirths. (chicagomalpracticeteam.com)
  • An experienced Chicago umbilical cord birth injury attorney at our firm can help. (chicagomalpracticeteam.com)
  • The March of Dimes underscores that most umbilical cord conditions will not result in harm to a baby, but some umbilical cord issues can lead to birth defects or to stillbirths. (chicagomalpracticeteam.com)
  • If your baby was born with birth defects that may have resulted from an undiagnosed or negligently managed umbilical cord condition or complication, or if you experienced a stillbirth, it is important to seek advice from one of our Chicago umbilical cord birth injury attorneys. (chicagomalpracticeteam.com)
  • A Glendale umbilical cord birth injury lawyer from our team can help you determine how to recover compensation. (birthinjurylawyer.com)
  • You could get compensation for any additional medical expenses you had due to the umbilical cord birth injury. (birthinjurylawyer.com)
  • You could be compensated for the physical and emotional stress both you and your baby have had to go through because of the umbilical cord birth injury. (birthinjurylawyer.com)
  • If your doctor failed to recognize or treat one of these complications, consider working with our Glendale umbilical cord birth injury lawyer on your case. (birthinjurylawyer.com)
  • Maternal obstetrical or labour ward complications can take many forms and they can affect the course of birth options and post-natal (afterbirth) outcome for both mother and baby. (medicallaw.ie)
  • Medical complications such as uterine rupture, cervical laceration, liver injury and clotting abnormalities require timely recognition and management to prevent permanent injury or sadly in rare cases in the death of the mother during the birth process. (medicallaw.ie)
  • When Do Birth Complications Happen? (gilmanbedigian.com)
  • Medical malpractice attorneys have experience in these types of birth injury cases and may be familiar with the type of birth complication your family is dealing with. (gilmanbedigian.com)
  • It was a traumatic birth with the cord wrapped around his neck. (friendsofserenity.org)
  • However, later in pregnancy, many women fear the thought of the umbilical cord wrapping around the baby's neck and the possibility of problems during delivery or even a stillbirth. (imumz.com)
  • If, for example, the obstetrician fails to monitor a pregnant woman's weight gain or diabetes during pregnancy and her excessive weight gain results in fetal macrosomia (a fetus above the average weight for its gestational age), the obstetrician may be found liable for childbirth complications, such as shoulder dystocia, that are found to have occurred as a result of the fetal macrosomia. (thebirthinjuryfirm.com)
  • But what happens if, shortly after your baby was born, you discovered that your little one sustained a nuchal cord injury during childbirth? (srbhawaiilaw.com)
  • Childbirth complications are difficulties encountered during childbirth with the mother, fetus, or both, and may take many forms. (thebirthinjuryfirm.com)
  • The failure of medical professionals to recognize and appropriately handle any of these and other childbirth complications may lead to serious injury or death of a fetus. (thebirthinjuryfirm.com)
  • The mismanagement of a childbirth complication during labor or delivery may result in injury or death to either or both patients and subject medical personnel to legal liability if the negligence of such personnel was a cause of the injury or death. (thebirthinjuryfirm.com)
  • Negligent treatment of a woman during her pregnancy may also result in childbirth complications for which medical personnel may be held liable. (thebirthinjuryfirm.com)
  • If the obstetrician breaches this standard of care by negligently failing to detect conditions that may lead to childbirth complications, the obstetrician may be found liable in a medical malpractice action for the fetus's injury or death resulting from the undetected condition. (thebirthinjuryfirm.com)
  • Is the Doctor Responsible for Childbirth Complications? (gilmanbedigian.com)
  • However, other complications can be caused by the doctors, nurses, or medical staff failing to provide proper care during pregnancy, labor, and childbirth. (gilmanbedigian.com)
  • When a doctor is responsible for childbirth complications, they may not come out and admit to doing anything wrong. (gilmanbedigian.com)
  • If you or your child suffer in childbirth complications and you suspect the doctor was to blame, talk to a medical malpractice team to understand your legal options. (gilmanbedigian.com)
  • Complications can happen at any time along the childbirth timeline, from the initial pregnancy to after the child is born. (gilmanbedigian.com)
  • What Are Common Childbirth Complications? (gilmanbedigian.com)
  • This can, in turn, lead to a range of complications like developmental delays, heart issues, meconium aspiration syndrome or even infant mortality. (headleyfirm.com)
  • For this reason, pregnant women diagnosed with nuchal cord in the third trimester can deliver vaginally, but they should be carefully monitored in terms of meconium and related complications. (dergipark.org.tr)
  • Cardiovascular complications are the leading non-obstetric cause of maternal morbidity and mortality during pregnancy [ 1 ]. (biomedcentral.com)
  • 4. Collins JH, Collins CL, Weckwerth SR, De Angelis L. Nuchal cords: timing of prenatal diagnosis and duration. (dergipark.org.tr)
  • 3. Clapp JF, Stepanchak W, Hashimoto K, Ehrenberg H, Lopez B. The natural history of antenatal nuchal cords. (dergipark.org.tr)
  • The cause of a missing umbilical cord artery is unknown but 20% of babies born with this condition suffer from health problems, such as difficult digestion, heart conditions and kidney dysfunction, along with genetic abnormalities, such as cleft lip. (fronzutolaw.com)
  • Umbilical cord abnormalities are numerous, ranging from false knots, which have no clinical significance, to vasa previa, which often leads to fetal death. (medscape.com)
  • The umbilical cord connects the mother's body to the developing fetus, and has three primary functions: supplying oxygen, delivering nutrients and taking away depleted nutrients and carbon dioxide. (matzuslaw.com)
  • If the cord gets wrapped around the neck of a fetus (a condition known as the nuchal cord), the brain may be deprived of oxygen. (headleyfirm.com)
  • however, the length of the cord is thought to reflect movement of the fetus in utero. (medscape.com)
  • The umbilical cord is an important part of every pregnancy, allowing a fetus to grow in the womb and to receive the oxygen, blood, and nutrients necessary to reach full term for a healthy newborn. (chicagomalpracticeteam.com)
  • The test for Brudzinski's sign and Kernig's sign are very common for the diagnosis of meningitis and also nuchal rigidity. (allhealthpost.com)
  • Once the diagnosis of diabetes is established in a pregnant woman, continued testing for glycemic control and diabetic complications is indicated for the remainder of the pregnancy. (medscape.com)
  • Nuchal cords are typically checked for by running the finger over the baby's neck once the head has delivered. (wikipedia.org)
  • citation needed] Williams Obstetrics 16th Edition, has only one single sentence in the entire textbook regarding cords around the neck. (wikipedia.org)
  • Presence of the cord was sought in the transverse and sagittal plane of the neck. (wikipedia.org)
  • A nuchal cord was diagnosed if the cord was visualized lying around at least 3 of the 4 sides of the neck. (wikipedia.org)
  • It is also possible for the umbilical cord to become compressed against itself or against the baby's neck, which reduces the amount of oxygenated blood that flows through the umbilical cord. (srbhawaiilaw.com)
  • When the umbilical cord is wrapped tightly around the baby's neck, it can cause a lack of oxygen to the brain. (srbhawaiilaw.com)
  • Most babies with a nuchal cord had just a single loop around the neck. (imumz.com)
  • An umbilical chord that is wrapped around a baby's neck in the womb is called a nuchal chord. (imumz.com)
  • The baby moves around quite a bit and that may end up in the chord wrapping around its neck. (imumz.com)
  • Firstly, it is based on how many times the chord is wrapped around the foetal neck which leads to the terms single nuchal chord, double nuchal chord, etc. (imumz.com)
  • The umbilical cord can even be wrapped around a baby's neck multiple times. (latonalaw.com)
  • Nuchal rigidity is also one of the problems associated with neck wherein the patient suffers an unnatural stiffness in the neck muscles. (allhealthpost.com)
  • Nuchal rigidity is a health condition wherein the patients experience rigidity in the neck muscles which renders them unable to flex forward the head. (allhealthpost.com)
  • When I was pregnant the doctors found an increased nuchal behind Jacob's neck on our 12 week scan. (friendsofserenity.org)
  • A nuchal cord does not get tighter as labour progresses. (imumz.com)
  • It's not like the baby is descending down during labour and the chord remains up there. (imumz.com)
  • Nuchal cord can lead to acidosis, an increased need for cesarean section, a low Apgar score, growth restriction, and severe spastic cerebral palsy [ 9 ]. (e-cep.org)
  • Severe umbilical cord compression can lead to serious health concerns for babies. (latonalaw.com)
  • If severe umbilical cord compression goes untreated, it can lead to brain damage or death. (latonalaw.com)
  • While the umbilical cord is the baby's lifeline as it grows and develops, it could also be the source of issues that endanger their life. (fronzutolaw.com)
  • We all know that the umbilical chord is a lifeline for a baby. (imumz.com)
  • According to the Cleveland Clinic , the umbilical cord "is the baby's lifeline to the mother during pregnancy" because it "transports nutrients to the baby and also carries away the baby's waste products. (chicagomalpracticeteam.com)
  • Even in these cases, it's rare for the chord to tighten enough to become dangerous. (imumz.com)
  • [ 2 ] Umbilical cord length was not significantly different when measured at different points in the third trimester. (medscape.com)
  • Adverse umbilical cord conditions such as a prolapsed cord, nuchal cord, umbilical cysts, knotted cord, or single umbilical artery, can seriously compromise the health of your baby and may lead to permanent harm if your doctor fails to diagnose or adequately manage the condition. (fronzutolaw.com)
  • Umbilical cord cysts are sacs of fluid in the umbilical cord. (wkw.com)
  • This can include using special maneuvers while the baby is being delivered or performing a cesarean section (c-section) to avoid complications. (latonalaw.com)
  • Sometimes if the cord is tightly wrapped, it is clamped and cut before the shoulders are delivered. (merckmanuals.com)