Umbilical cord prolapse is where the umbilical cord descends through the cervix, with (or before) the presenting part of the fetus. It affects 0.1 - 0.6% of births. Show Cord prolapse occurs in the presence of ruptured membranes, and is either occult or overt:
Although the incidence is relatively low, the mortality rate for such babies is high (~91 per 1000). This is largely because cord prolapse occurs more frequently in preterm babies, who are often breech, and who may also have other congenital defects. In this article, we shall look at the risk factors, clinical features and management of cord prolapse. PathophysiologyUmbilical cord prolapse is where the umbilical cord descends through the cervix, with (or before) the presenting part of the fetus. Subsequently, fetal hypoxia occurs via two main mechanisms:
Risk FactorsThe main risk factors for cord prolapse include:
[caption id="attachment_14008" align="aligncenter" width="312"] Fig 1 - A footling breech and umbilical cord prolapse.[/caption]Clinical Features and Differential DiagnosisCord prolapse should always be considered in the presence of a non-reassuring fetal heart rate pattern and absent membranes. It can be confirmed by external inspection or on digital vaginal examination. This is one of the reasons that vaginal assessment, after abdominal examination, encompasses a full assessment in the presence of a non-reassuring fetal heart rate pattern. The fetal heart rate patterns can vary from subtle changes, such as decelerations with some of the contractions, to more obvious signs of fetal distress, such as a fetal bradycardia. The latter is strongly associated with cord prolapse; relating to the mechanism of occlusion of the cord by the presenting part. An alternative diagnosis may be considered in the presence of bleeding per vagina or heavily blood-stained liquor with ruptured membranes. This would suggest placental abruption (the placenta starts to separate from the uterine wall) or vasa praevia (fetal vessels running in the fetal membranes adjacent to the internal os of the cervix). ManagementFirstly, call for help - umbilical cord prolapse is an obstetric emergency. It should be managed as follows:
[caption id="attachment_14003" align="aligncenter" width="531"] Fig 2 - The knee-chest position, used in the management of cord prolapse.[/caption][start-clinical] Summary
[end-clinical] Advances in the management of umbilical cord prolapse hold promise for reducing perinatal morbidity and mortality. This article reviews traditional nursing management of umbilical cord prolapse and introduces the use of real‐time ultrasound and bladder filling as additional methods of nursing management. A case report is provided. Time is of the essence in the nursing management of UCP. Although traditional nursing interventions are effective for the management of UCP, real‐time ultrasound and bladder filling have been proven in the medical literature and clinical studies to reduce the perinatal morbidity and mortality in such instances. In accordance with nurse practice acts and institutional policies, nurses can be qualified to perform these advanced assessments and implementations. For nurses in offices, clinics, and rural hospitals, bladder filling can be an effective intervention that will allow time for the necessary transportation of the patient and preparations for cesarean delivery. With these advances in patient care, nurses can be instrumental in promoting positive perinatal outcomes for patients with UCP. To read this article in full you will need to make a payment DOI: https://doi.org/10.1111/j.1552-6909.1993.tb01811.x © 1993 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.
This condition occurs when the umbilical cord drops (prolapses) between the fetal presenting part and the cervix into the vagina. Umbilical cord prolapse occurs prior to or during delivery of the baby. The overall incidence is reported at 0.16%-0.18% or approximately one in every 300 births. What is the umbilical cord?The umbilical cord is a flexible, tube-like structure that, during pregnancy, connects the fetus to the mother. The umbilical cord is the baby's lifeline to the mother. It transports nutrients to the baby and also carries away the baby's waste products. It is made up of three blood vessels – two arteries and one vein. What are the consequences of umbilical cord prolapse?Umbilical cord prolapse is an uncommon but potentially fatal obstetric emergency. When this occurs during labor or delivery the prolapsed cord is compressed between the fetal presenting part and the cervix. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.
Umbilical cord prolapse is diagnosed by seeing or palpating the prolapsed cord on pelvic exam. In addition, the baby may have an abnormal fetal heart rate known as bradycardia (a heart rate of less than 120 beats per minute).
Umbilical cord prolapse is an acute obstetric emergency that requires immediate delivery of the baby. The route of delivery is usually by cesarean section. The doctor will relieve cord compression by manually elevating the fetal presentation part until cesarean section is performed. This reduces the risk of fetal oxygen loss. If the problem with the prolapsed cord can be solved immediately, there may be no permanent injury. However, the longer the delay, the greater the chance of problems (such as brain damage or death) for the baby.
Last reviewed by a Cleveland Clinic medical professional on 09/09/2020. References
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy |