The umbilical cord is your baby's lifeline to nutrients and oxygen. An emergency arises when the umbilical cord leaves the body before the infant during delivery. The baby can lose their vital connection to nutrients and oxygen. What does an umbilical cord prolapse, a rare obstetrical emergency, mean for you and your baby?
An umbilical cord prolapse is when the umbilical cord exits the cervix before your baby.
Umbilical cord prolapse is potentially life-threatening for your newborn, as oxygen supply can be severely limited.
If a cord prolapse is identified, immediate delivery is the most common next step.
Your obstetric provider can anticipate risk but prevention is not always possible.
What is an umbilical cord prolapse?
An umbilical cord prolapse is when the umbilical cord, your baby's connection to the placenta, emerges before they do. When this happens, the blood and oxygen supply from you to your baby can be severely diminished or lost. This interruption can lead to significant fetal distress and, potentially, death. Two types of cord prolapse can occur:
- Overt prolapse. The umbilical cord leaves through the cervix before the baby's presenting body part. The cord can be visible or felt during a vaginal exam. The fetal heart monitor may show concerning fetal heart rate abnormalities.
- Occult prolapse. The umbilical cord exits the cervix with the fetal presenting body part. In this case, the cord is not visible or felt during a vaginal exam. The fetal heart monitor may show fetal distress, though not always.
Causes of an umbilical cord prolapse
Umbilical cord prolapses are uncommon. Up to 50% of cases result from a medical procedure or treatment. Causes of prolapse include:
|Cause of prolapse
|Breaking of the water
|Cord prolapse can happen when the membranes rupture spontaneously or artificially before a fetal body part, preferably the head, is well engaged. This rupture can leave space for the freely floating cord to slip down and out. This accounts for approximately 25% of prolapse cases.
|Fetal scalp electrode or intrauterine pressure catheter insertion
|The use of monitoring tools that require water breaking can increase the risk of prolapse if a baby's head is not engaged in the pelvis.
|Cervical ripening balloon insertion
|These internal, fluid-filled balloons place pressure on the cervix to cause manual dilation, or opening of the cervix.
|Mother giving birth more than five times
|This is called grand multiparity.
|Too much amniotic fluid
|Polyhydramnios is common in conditions such as gestational diabetes.
|Malpresentation of the newborn
|A baby in a breech or side-lying position is at greater risk of cord prolapse.
|Preterm, premature rupture of membranes
|When the water breaks before the 37th week of pregnancy, there are many risks to the pregnancy, including cord prolapse.
|Multiple gestation pregnancies
|Twins, triplets, and more are at greater risk of cord prolapse.
Symptoms of umbilical cord prolapse
There are no symptoms of an umbilical cord prolapse for the pregnant parent. Signs are generally heard or visible in the fetal heart rate, but only in about two-thirds of fetuses. Your obstetrician or midwife and labor and delivery nurses are specially trained to understand changes that occur in the fetal heart rate. Heart rate changes that should be immediately investigated by medical staff include:
- Slowing of baby's heart rate. This is called fetal bradycardia.
- Deep dips in baby's heart rate. These are called variable decelerations that may or may not occur during a contraction. This can mean that the umbilical cord is being compressed.
Whether you are giving birth in your home or a hospital setting, your birth attendant, midwife, nurse, or physician will perform a vaginal exam to see if a cord can be felt inside the vagina. Other obstetric findings, complications, and emergencies can also cause these fetal heart rate changes.
In rare occurrences, the umbilical cord may be visible outside the vagina. In this case, the cord must be kept moist and warm. The cold air temperature can cause the blood vessels within the cord to spasm and close up or constrict, further decreasing oxygen flow to the baby.
Treatment – what to expect:
The discovery of an overt umbilical cord prolapse is an emergency and is life-threatening to your baby. Treatment involves two main steps:
- Getting the pressure off the umbilical cord. This is called fundic decompression. A hand inside the vagina will push the baby's presenting part up to relieve pressure on the cord. This gentle manual pressure will remain until delivery to keep blood and oxygen flowing to the infant.
- Delivering the baby. Most times, delivery will be by emergency cesarean section.
The most critical step for the baby's well-being is to decrease pressure on the cord, no matter how long delivery takes. This is a crucial step if an umbilical cord prolapse is discovered at home. Other steps may include:
- Contraction-stopping medication. Stopping contractions will increase blood flow to the placenta and the umbilical cord.
- Trendelenburg positioning. The patient lies on their back with their head angled down and feet pointing up to relieve pressure in the pelvis.
- Filling the bladder with fluid. Fluid is inserted through a tube placed in the urethra to relieve additional pressure on the cord.
How to prevent umbilical cord prolapse
Preventing an umbilical cord prolapse is difficult, but recognizing the risks can help obstetric providers anticipate its possibility.
Artificial breaking of water or membranes is the most common risk factor for cord prolapse. Providers must be cautious during this artificial breaking of the water. The fetal heart rate is continuously monitored during the slow and controlled membrane rupture.
Can a baby survive a cord prolapse?
Fetal death due to an umbilical cord prolapse is less than 10%. This rate has dramatically improved over the years, as cesarean sections have become more available, and improvements have been made in infant CPR. However, fetal death increases to nearly 50% if a prolapse occurs outside the hospital setting.
Gestational age (number of weeks pregnant) and birth weight will also determine a baby's chance for survival and health outlook after delivery. Babies born prematurely and with low birth weight are at risk for many underlying conditions that can impact well-being.
An umbilical cord prolapse can be scary and dangerous. But, because of many medical advances, the chances of infant survival are excellent. It is essential to know what to expect during an obstetric emergency when the primary goals are to keep you and your baby safe and well.