Umbilical Cord Prolapse

June 10, 2008 - 7:30am

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Umbilical Cord Prolapse

Pronounced: um-BILL-ick-ul cord PRO-lapse

Definition

Umbilical cord prolapse is a condition during the last stages of pregnancy in which the umbilical cord descends into the vagina prematurely—most often after the membranes have ruptured and the baby moves into the birth canal for delivery.

As the baby passes through the vagina during delivery, it puts pressure on the cord, which can decrease or cut off the infant’s blood supply.

Umbilical cord prolapse is a very dangerous condition that can cause stillbirth unless the baby is delivered quickly, usually by cesarean section]]> , after the condition is diagnosed. Other complications include brain damage from lack of oxygen. Most babies delivered quickly through cesarean section don’t suffer from complications caused by this condition.

Umbilical cord prolapse is relatively common, occurring in one in every 300 births.

Umbilical Cord Prolapse

Causes

The most common cause of umbilical cord prolapse is the premature rupturing of the membranes containing amniotic fluid. Other common causes include:

Premature delivery]]>
Multiple births (twins, triplets, etc.)
Excessive amounts of amniotic fluid (polyhydramnios)
Breech delivery (feet first)
Abnormally long umbilical cord

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

The following factors increase your chance of developing umbilical cord prolapse:

Having a baby that is in the breech position
Premature rupture of the membranes
Multiple births in one pregnancy—the second baby delivered is at greater risk
Having an unusually long umbilical cord
Too much amniotic fluid in the membranes
Rupturing the membranes to induce or speed up labor

Symptoms

The symptoms of umbilical cord prolapse include seeing or feeling the umbilical cord in the vagina prior to the baby's delivery. Low heart rate of less than 120 beats per minute is also a symptom that the baby is in distress from umbilical cord prolapse.

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical and pelvic exam.

Tests may include the following:

Heart rate monitoring of the mother and baby
Pelvic examination to see and feel the umbilical cord present in the vagina

Treatment

Treatment options include:

Cesarean Section

If the baby can’t be quickly delivered without risk of insufficient oxygen, then the baby will be delivered by cesarean section.

Cesarean Delivery

Removing Pressure From the Cord

In some cases, the doctor may be able to move the baby away from the cord so as not to disrupt oxygen supply to the baby. The mother may also be asked to move into a position that removes pressure from the cord and protects the baby.

Rapid Delivery

If the mother is ready to deliver, the doctor may try to deliver the baby very quickly using forceps or a vacuum extractor.

Prevention

Umbilical cord prolapse is difficult to prevent, but if you have risk factors, talk to your doctor about cesarean section and other ways to help prevent the risk of umbilical cord prolapse.

RESOURCES:

American Pregnancy Association
http://www.americanpregnancy.org/labornbirth/reasonsforacesarean.html

Fairview Health Services
http://www.fairview.org/healthlibrary/content/wha_proco_wha.htm

Mayo Clinic
http://www.mayoclinic.com/health/c-section/PR00078

CANADIAN RESOURCES:

British Columbia Ministry of Health
http://bchealthguide.org/kbase/topic/special/tn8162/sec1.htm

The Society of Obstetricians and Gynaecologists of Canada
http://sogc.medical.org/

References:

The references below are cited on the following website: Umbilical cord abnormalities. Quick References and Fact Sheets. March of Dimes website. Available at: http://www.marchofdimes.com/professionals/14332_4546.asp .
Catanzarite VA et al. The two-vessel cord: how concerned should we be? Contemporary Ob/Gyn . 1997 Apr: 43-54.
Collins JH et al. Silent Risk: Issues about the Human Umbilical Cord . 2002 Jun 14.
Cunningham FG et al. Abnormalities of the umbilical cord in: Williams Obstetrics . 21st ed. New York: McGraw-Hill Medical Publishing Division; 2001.
Dildy GA, Clark SL. Umbilical cord prolapse. Contemporary Ob/Gyn . 1993 Nov: 23–31.
Lee W et al. Vasa previa: prenatal diagnosis, natural evolution, and clinical outcome. Obstet Gynecol . 2000 Apr;95(4):572–576.

Prolapsed umbilical cord. Women's Health Advisor. University of Michigan Health System website. Available at: http://www.med.umich.edu/1libr/wha/wha_proco_crs.htm . Accessed July 4, 20.07.

Umbilical cord prolapse. The Cleveland Clinic Health Information Center website. Available at: http://www.clevelandclinic.org/health/health-info/docs/3800/3870.asp?index=12345 . Accessed July 4, 2007.

Last reviewed November 2008 by ]]>Jeff Andrews, MD, FRCSC, FACOG]]>

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.