Umbilical Cord Prolapse

Prolapse of the umbilical cord is a condition in which the umbilical cord protrudes from the cervix before the baby is born. This condition can occur due to rupture of the water sac, abnormal position of the fetus, or short umbilical cord.

The umbilical cord contains vessels that deliver oxygen and nutrients to the fetus. If the umbilical cord is compressed or twisted, the blood flow to the fetus is cut off and can lead to serious injuries or even death of the fetus.

If you develop a prolapsed cord while you’re in the hospital, you’ll be taken care of right away and possibly have an emergency C-section.

What happens when the umbilical cord prolapses?

It is a medical emergency that requires immediate attention. It occurs when the umbilical cord slips down into the vagina before the baby’s head or other presenting part, potentially compressing the cord and reducing blood flow to the baby. Symptoms include:

A visible cord.
A feeling of something coming out.
A slow or irregular fetal heart rate.

Symptom of umbilical cord prolapse

The most common symptom of umbilical cord prolapse is a visible cord protruding from the vagina. This can occur before, during, or after the amniotic sac rupture.

What is the cause of the umbilical cord prolapsing?

There is nothing specific that causes the umbilical cord to prolapse. Instead, several factors increase the risk of falling. Since most cases occur after the water breaks, healthcare providers know that the flow of amniotic fluid can play a role. However, this is not the only reason. The most common causes of umbilical cord prolapse are:

Breech presentation
Polyhydramnios
Premature rupture of membranes
Multiple pregnancies

Who is most at risk of a prolapsed umbilical cord?

Several factors can increase the risk of umbilical cord prolapse. These include:

Premature birth: Babies born before 37 weeks of pregnancy are more at risk of prolapsed umbilical cord.
Large amounts of amniotic fluid: Having more amniotic fluid than usual can increase the risk of umbilical cord tying or slipping.
Multiple pregnancy: Twins or triplets are more prone to cord prolapse than singletons.
Previous prolapsed umbilical cord: If you have had a prolapsed umbilical cord in a previous pregnancy, you are at a higher risk of having it happen again.
Placenta previa occurs when the placenta is at the bottom of the uterus, near or above the cervix, which can increase the risk.

Types

Umbilical cord prolapse can be classified into two main types:

Overt prolapse: In this type, the umbilical cord is visible outside the vagina.
Occult prolapse: In this type, the umbilical cord is not visible outside the vagina, but it is still compressed between the baby’s presenting part and the cervix.

It’s important to note that both types of umbilical cord prolapse can be serious and require immediate medical attention.

How is it diagnosed?

If you are in the hospital, your doctor may diagnose a prolapsed umbilical cord after seeing or feeling it during a vaginal exam.

A prolapsed umbilical cord can be diagnosed during a medical examination. You may feel the umbilical cord in your vagina, or your healthcare professional may feel it during a vaginal exam.

For some women, the only sign of a prolapsed umbilical cord is that the baby has an abnormal heartbeat. An abnormal heartbeat in your unborn baby can occur in 67 percent of cord prolapse cases. This happens because the umbilical cord is stretched and compressed, slowing the blood flow to the baby. This causes sudden drops or changes in the baby’s heart rate.

What is the treatment of umbilical cord prolapsing?

A prolapsed umbilical cord is a medical emergency that requires immediate attention. Treatment usually includes the following:

Emergency C-section: This is often the quickest and safest way to deliver and prevent further damage to the baby.
Manual replacement: In some cases, the health care provider may be able to manually replace the umbilical cord, allowing the baby to be delivered vaginally. However, this is risky and should only be attempted under special circumstances.
Knee-chest position: This position can help reduce pressure on the umbilical cord and improve blood flow in the baby. This involves getting on your hands and knees with your hips higher than your shoulders.

Can cord prolapse be prevented?

While it’s not always possible to prevent umbilical cord prolapse, there are some steps you can take to reduce your risk:

Prenatal care: Regular prenatal check-ups can help identify potential risk factors early on.
Avoid excessive amniotic fluid: If you’re at risk of having too much amniotic fluid, your healthcare provider may recommend certain treatments to reduce the amount.
Limit activity: If you’re at risk of umbilical cord prolapse, your doctor may recommend limiting your activity or avoiding strenuous exercise.
Know the signs: Be aware of the symptoms of umbilical cord prolapse so that you can seek immediate medical attention if you experience them.

It’s important to note that even if you take these steps, umbilical cord prolapse can still occur. If you have any concerns about your risk, please discuss them with your healthcare provider.

Can a baby survive a prolapsed umbilical cord?

Yes, most babies survive cord prolapse. The in-hospital mortality rate for babies with prolapsed umbilical cord is about 3%, although one study put the rate as high as 7%. The outlook for cord prolapses when it occurs outside the hospital is poor.

The bottom line

This tube-shaped structure connects the baby to the placenta. The umbilical cord has blood vessels that carry oxygen and nutrients to the baby and remove waste products.

A prolapsed umbilical cord occurs when the umbilical cord comes through the cervix into the vagina, actually before the baby enters the birth canal. When this happens, the umbilical cord is compressed between the body and the pelvic bones, which is dangerous for the baby and leads to reduced blood and oxygen flow.

In these cases, the baby should be born immediately to avoid the risks of lack of oxygen. Fortunately, this complication is not common. Considering the importance of prolapse of the umbilical cord and its severe consequences for the health of the mother and the fetus, accurate recognition of the symptoms, timely diagnosis, and appropriate treatment measures are of great importance.

Prolapse of the umbilical cord is a complex and dynamic condition in which various factors may be involved. Therefore, more research is necessary to better understand this complication’s mechanisms and develop more effective prevention and treatment methods.

Finally, it is recommended that pregnant women visit their doctor regularly and see a doctor without wasting time if they notice any unusual symptoms.

Additional questions

What happens if the amniotic sac ruptures?

The significant risk of PPROM is that the baby is more likely to be born within days of the membrane rupture. Another important risk of PROM is the development of a serious infection in the tissues of the placenta called chorioamnionitis, which can be very dangerous for the mother and the baby.

What happens to the placenta in multiple births?

While fraternal twins (two eggs and two sperm) are always enclosed in their sacs and have separate placenta, 70% of identical twins may share a placenta. Only 1% of identical twins share a single placenta and sac, a significant risk.

What is the healthiest position in which to give birth?

There’s no universally “healthiest” position for giving birth. The best position for you depends on your preferences, comfort level, and the specific circumstances of your labor.

What is the heart rate of the fetus during the week of pregnancy?

In this initial phase, the heart rate begins to slow (between 90 and 110 BPM). Weeks 8 to 12: Heart rate increases and averages 140 to 170 BPM by week 9. At week 12, the pulse slows down a bit. Weeks 13-26: For most of the pregnancy, the average is 110-160 BPM.