Umbilical cord prolapse | |
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Other names | Cord prolapse, prolapsed cord[1] |
Cord prolapse, as depicted in 1792 | |
Specialty | Obstetrics |
Risk factors | Abnormal position of the baby, prematurity, twin pregnancy, multiple prior pregnancies[2][3] |
Diagnostic method | Suspected based on a sudden decrease in baby's heart rate during labor, confirmed by seeing or feeling the cord in the vagina[4] |
Differential diagnosis | Abruptio placentae[2] |
Treatment | Rapid delivery, usually by cesarean section.[4] |
Prognosis | Risk of death of the baby 10%[2] |
Frequency | < 1% of pregnancies[4] |
Umbilical cord prolapse is when the umbilical cord comes out of the uterus with or before the presenting part of the baby.[2] The concern with cord prolapse is that pressure on the cord from the baby will compromise blood flow to the baby.[2] It usually occurs during labor but can occur anytime after the rupture of membranes.[1][5]
The greatest risk factors are an abnormal position of the baby within the uterus and a premature or small baby.[2] Other risk factors include a multiple pregnancy, more than one previous delivery, and too much amniotic fluid.[2][3] Whether medical rupture of the amniotic sac is a risk is controversial.[2][3] The diagnosis should be suspected if there is a sudden decrease in the baby's heart rate during labor.[4][2] Seeing or feeling the cord confirms the diagnosis.[4]
Management focuses on quick delivery, usually by cesarean section.[4] Filling the bladder or pushing up the baby by hand is recommended until this can take place.[4] Sometimes women will be placed in a knee-chest position or the Trendelenburg position in order to help prevent further cord compression.[2] With appropriate management, the majority of cases have good outcomes.[4]
Umbilical cord prolapse occurs in about 1 in 500 pregnancies.[2] The risk of death of the baby is about 10%.[2] However, much of this risk is due to congenital anomalies or prematurity.[2] It is considered an emergency.[4]