Umbilical Cord Prolapse

Learn about umbilical cord prolapse.

What is umbilical cord prolapse?

Umbilical cord prolapse occurs when the umbilical cord comes out of the uterus either with or before the fetus during childbirth. This occurs in less than 1% of pregnancies and is more likely to occur in women whose amniotic sac has ruptured. The first sign of umbilical cord prolapse is a sudden drop in fetal heartrate that does not return to normal. In some cases, the umbilical cord can be felt or seen upon examination. This condition is cause for concern because it results in compression of the blood flow to the fetus and is therefore considered an emergency situation during labor. As a result, some deliveries where umbilical cord prolapse occurs result in a necessary cesarean section (C-section) but will often have successful results for the mother and child.

Types

There are three types of prolapse that can occur.

• Overt umbilical cord prolapse, the most common type, occurs with the rupture of membranes. In this type, the cord has come through the cervix and into or even beyond the vagina, past the fetus.
• Occult umbilical prolapse can occur with either intact or ruptured membranes. In occult prolapse, the cord is seen alongside the fetus but has not passed it.
• Funic presentation happens when membranes have not yet ruptured. The cord is between the fetus and the fetal membranes but has not yet passed the opening of the cervix.

Risk factors

The risk factors that accompany this condition either make it difficult for the fetus to fill the pelvis appropriately or are related to abnormalities of the umbilical cord itself. These known risk factors can be divided into two categories: spontaneous or iatrogenic (resulting from medical intervention). Spontaneous factors include fetal malpresentation, in which the fetus takes up space in such a way that there is room for the cord to sit below it; an abnormally high amount of amniotic fluid; prematurity and/or low birth weight; multiple pregnancy, such as with twins or triplets; and the spontaneous rupture of membranes. Factors resulting from medical intervention include the artificial rupture of membranes, manual rotation of the baby’s head, or placement of internal monitors.

Treatment

In the case of umbilical cord prolapse during labor, the most common course of action is to help the mother to delivery in the quickest way possible, which often results in a C-section. When preparing for delivery, some medical interventions can be made in order to decrease the likelihood of this complication. These include manual elevation of the fetus, moving the mother so that her feet are elevated, filling the bladder in order to elevate the fetus, using medications to suppress labor, introducing oxygen to the mother, or a combination thereof. If the mother is not close to starting labor, a manual funic reduction, where the cord is placed back into the uterine cavity, can be performed.