Umbilical Cord Prolapse

What is umbilical cord prolapse?

Umbilical cord prolapse is a complication that occurs during labor, usually just before or during delivery. It happens when the umbilical cord drops (prolapses) out of its normal position and comes out of your cervix before your baby. In a typical delivery, your baby comes out first, followed by the umbilical cord. But, in a prolapse, the umbilical cord drops through your cervix and into your vagina before your baby does. When this happens, the umbilical cord can get squished between your baby’s body and your cervix or vagina.

What is the umbilical cord?

The umbilical cord is a flexible, tube-like structure that transports nutrients and oxygen to the fetus during pregnancy.

What happens when the umbilical cord prolapses?

A prolapsed umbilical cord is a medical emergency because it cuts off your baby’s blood and oxygen supply during delivery. Ideally, your baby drops down through your dilated cervix before the umbilical cord. When the umbilical cord comes first, it can get squished by your baby’s body. Each contraction of your uterus further squeezes the cord. When the cord is exposed to the air, the umbilical cord narrows, which also affects blood flow. Umbilical cord prolapse has the potential to cause severe and permanent disabilities.

Types of umbilical cord prolapse

Umbilical cord prolapse can be overt or occult (nonovert).

• An overt prolapse means that the cord slips down into your cervix and vagina ahead of your baby during delivery.
• In an occult umbilical cord prolapse, the cord slips out alongside (not before) your baby.

How common is this condition?

Prolapsed umbilical cords occur in about 1 in every 300 births. However, some studies say the rate is declining and may occur in 1 in 1,000 births.

What is the most common symptom of umbilical cord prolapse?

Your pregnancy care provider may suspect a cord compression issue if:

• They can see or feel the umbilical cord after your water breaks.
• The fetal heart rate drops, slows or changes suddenly.

However, some cases of prolapse occur with no outward symptoms.

One study estimates that over half of prolapses occur within five minutes after the membranes rupture (your water breaks) and up to 70% occur within one hour of your water breaking.

What causes umbilical cord prolapse?

There isn’t one specific thing that causes umbilical cord prolapse. Rather, there are several factors that increase your risk for prolapse.

Since most cases occur after your water breaks, healthcare providers know the flow of amniotic fluid can play a role. However, this isn’t the only cause.

The most common causes of umbilical cord prolapse are:

• Breech presentation (when the fetus is in any position other than head first).
• You’re pregnant with twins, triplets or more (also known as having a multiple pregnancy).
• Polyhydramnios (you have too much amniotic fluid).
• Premature rupture of membranes (water breaking) before you reach full term.

Who is at risk for umbilical cord prolapse?

Umbilical cord prolapse can occur without any risk factors. However, certain conditions or factors may increase the chances of a prolapse occurring. In addition to the above causes, other risk factors include:

• Fetal congenital disorders.
• Placenta previa.
• Irregularly shaped umbilical cord (too long, very thin, etc.).
• Assisted vaginal delivery (using a vacuum or forceps during delivery).
• Low birth weight (weighing less than 5 pounds, 8 ounces, or 2.5 kilograms, at birth).
• Having had five or more babies already (multiparous).
• Irregular cord insertion (velamentous cord insertion).
• High fetal station (fetal station is the baby’s position relative to your pelvis during labor).
• Macrosomia (your baby is larger than average newborns).
• Procedures like amniotomy (your provider breaks your water) or inserting a balloon to ripen your cervix.

What are the complications of this condition?

Umbilical cord prolapse is an uncommon but potentially fatal emergency. When this occurs during labor or delivery, the prolapsed cord becomes compressed which results in the fetus losing oxygen. Prompt treatment is necessary to avoid life-threatening outcomes. The complications of a prolapsed cord include:

• Hypoxia.
• Hypoxic-ischemic encephalopathy (HIE) or birth asphyxia.
• Cerebral palsy.
• Permanent brain damage.
• Stillbirth.

What are the first signs of umbilical cord prolapse?

Your healthcare provider typically diagnoses umbilical cord prolapse by:

• Seeing or feeling the prolapsed cord during a vaginal exam.
• Detecting an abnormal fetal heart rate known as bradycardia (a heart rate of less than 120 beats per minute).
• Noticing a sudden change in your blood pressure.

How is an umbilical cord prolapse treated?

Umbilical cord prolapse is an obstetric emergency that requires immediate delivery most of the time. The safest and quickest route of delivery is usually by C-section.

Your healthcare provider will attempt to relieve cord compression by moving you to a knee-to-chest position or manually lifting your baby away from the cord. This temporarily reduces the risk of oxygen loss. However, delivery must occur as soon as possible to prevent potential life-threatening outcomes.

If the problem with the prolapsed cord can be solved immediately, there may be no injuries. However, the longer the delay, the greater the chance of complications.

Can a baby survive a cord prolapse?

Yes, most babies survive a cord prolapse. The rate of mortality for infants with umbilical cord prolapse in a hospital setting is about 3%, although one study has the rate as high as 7%. The outlook for umbilical cord prolapse when it occurs outside the hospital is poor. The risk of infant death is nearly 20 times higher in these cases.

Can umbilical cord prolapse be prevented?

No, you can’t prevent umbilical cord prolapse. It’s also hard to detect during pregnancy because the umbilical cord and fetus move frequently. Your healthcare provider can only act quickly when umbilical cord prolapse occurs.