Umbilical cord prolapse is a condition where the umbilical cord drops through the open cervix to the vagina before the baby during or before birth. This is an obstetric medical emergency, and usually, immediate delivery through C-section is recommended to avoid the risk of brain damage due to poor oxygenation. The umbilical cord connects the mother and the baby. The three umbilical blood vessels carry blood, oxygen, and nutrients to the babies. So, cutting the cord from the baby before birth can be life-threatening. Read on to know the causes, complications, and other factors related to umbilical cord prolapse.
What Is A Cord Prolapse?
Cord prolapse happens when the umbilical cord drops through the cervix and pushes into the birth canal before the baby. It gets trapped against the baby’s body, thereby blocking the blood and oxygen supply. Cord prolapse could be an obstetric emergency that can affect the baby’s health (1). Umbilical cord prolapse is likely to occur in one out of 500 pregnancies (2).
Types Of Cord Prolapse
Cord prolapse can be overt or occult, depending on how the baby is positioned.
Over prolapse is when the cord drops through the cervix or vagina before the presenting part (head) of the baby is visible or felt by the doctor. This is a very common type of umbilical cord prolapse.
Occult prolapse occurs when the cord drops along with the presenting part of the baby. It usually happens in the case of intact or ruptured membranes (3).
In both types, immediate delivery is required to prevent fetal distress.
Signs And Symptoms Of A Cord Prolapse
Considering that a cord prolapse occurs during or before delivery, doctors will check for the following signs to diagnose it:
Feeling or seeing the cord before the baby is the most apparent sign of cord prolapse.
Fetal distress that causes decreased heart rate due to lack of oxygen. The drop in the fetal heart rate is detected through the fetal monitor (4).
These signs may indicate complications in the delivery and therefore need immediate medical attention.
Most of the time, it precedes spontaneous rupture of membrane or succeeds its artificial rupture.
Causes Of Cord Prolapse
Several factors could lead to cord prolapse. Some of them are (4):
Premature rupture of the membranes (PROM): The amniotic sac could sometimes rupture too early or when the doctor performs amniotomy (procedure to accelerate labor). In these cases, when the baby’s head is too high in the uterus, the cord emerges first. The cord will then get compressed as the baby follows.
Polyhydramnios (excessive amniotic fluid): If there is an excess of amniotic fluid, the pressure of the fluid pushes out the cord forcefully before the baby.
Delivering multiples: In the case of twin babies or triplets, the first baby, while exiting, may push out the cord of another baby.
Malpresentation of the baby: A breech position is one of the unusual delivery presentations where the baby’s feet come out first, giving space for the cord to come out of the birth canal beforehand. Also, the side lie (transverse) position or oblique lie might cause the cord to come out first.
Premature delivery: The small fetal size combined with more amniotic fluid can trigger the cord to exit first.
Long cord: An umbilical cord that is longer than the usual might also cause a prolapse.
Funic presentation: A variation in the cord position where it is pointing towards the internal cervical opening or lower uterine segment.
The other risk factors associated with umbilical cord prolapse include:
Manual rotation of the fetal head
Low birth weight
Marginal insertion of cord, where it inserts into the edge of the placental disc
Uterine fibroids or muscle tumors of the uterus
Congenital uterine abnormalities such as septate, bicornuate, arcuate, unicornuate and didelphys uterus.
Cephalopelvic disproportion (baby’s head or body is too large)
Placenta previa (low-lying placenta)
Complications Of Cord Prolapse
A cord prolapse could lead to the following complications (2):
The fetal heart rate changes with cord compression, resulting in variable deceleration (irregular and jagged dips in fetal heart rate).
Changes in blood pressure due to lack of oxygen and changes in heart rate.
Respiratory acidosis occurs when the umbilical cord vein compresses, causing carbon dioxide to accumulate in the baby’s blood.
Prolonged cord compression will further affect the flow of blood and oxygen to the baby’s brain.
It can cause short bouts of fetal hypoxia (lack of oxygen in the womb), leading to fetal death.
How Is Umbilical Cord Prolapse Diagnosed?
The diagnosis of cord prolapse involves (4):
Detecting the baby’s heart rate using a fetal heart monitor. In the case of cord prolapse, the baby’s heart rate goes down to less than 120 beats per minute.
Pelvic examination to see or feel the cord using fingers.
Cord prolapse could be detected with an ultrasound before delivery. This is especially important in the case of fetus’ malrepresentation, multiple births, known as placental abnormalities.
What Can You Do If You Have A Cord Prolapse At Home?
Since cord prolapse leads to the risk of oxygen and blood deficiency to the fetus, it should be dealt with at the earliest. But how do you know if it is a cord prolapse? First, your water breaks, and you will feel that there is something (cord) in your vagina. In such a case, call for medical assistance as it is an obstetric emergency and take the following measures until help arrives.
With your partner’s help, remove the pressure off the cord by holding the presenting part up gently. Do not touch the cord as it may cause vasospasm.
With the cord compression, the oxygen supply to the baby is minimal. In this case, remain calm and take deep breaths to supply your baby with as much oxygen as possible.
While you wait, get on all the fours to take off the pressure from the cord (5).
You may also adopt knee-chest position or left lateral position by placing a pillow under the left hip.
Cord Prolapse Management And Treatment
At the hospital, your medical practitioner will first ask you to move into a comfortable position. The standard treatment is to encourage immediate delivery through the quickest and safest way possible. It involves c-section, especially when you are in early labor. Vaginal delivery might be attempted if it is considered safe. Other treatment interventions required to reduce the cord compression and lower the risk of fetal complications include:
Manually elevating the presenting fetal part through digital vaginal examination.
Filling the bladder with normal saline using a urinary catheter, to elevate the fetal part.
Moving the mother to a left lateral position, with the head down and feet elevated on pillows.
Giving tocolytics (medications that suppress labor) for uterine relaxation and to prevent contractions.
If the fetal heart rate is stable, the doctor might go for category 2 LUCS. But if the heart rate pattern is non-reassuring, they may go for immediate LUCS with verbal consent.
Can Cord Prolapse Be Prevented?
There are no definite methods to prevent umbilical cord prolapse, but there are some things you can do to lower the risk of this complication.
Avoid cervical checks as they carry the risk of accidental rupturing of the membranes.
Avoid lifting heavy weights and indulging in vigorous physical activities that could lead to the water breaking before it is time for natural labor.
If the situation demands labor induction, go for a c-section as it is a safer alternative.
If you are aware of conditions such as polyhydramnios or fetal positioning, prepare in advance for any risks.
