Why cord prolapse

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While rare, a baby's umbilical cord can occasionally forget its place and make an unexpected appearance. Back to Top. In This Article.

Continue Reading Below. Recommended Reading. When Does Baby Drop? Induction of labour with prostaglandins is not associated with an increased risk of cord prolapse. A Cochrane review showed no difference in the risk of cord prolapse between women who had artificial rupture of the membranes to speed up labour and those who did not [ 5 ]. Have a high index of suspicion for cord prolapse, particularly if fetal monitoring changes occur soon after rupture of membranes, whether spontaneous or with amniotomy.

Routine antenatal ultrasound is not adequately sensitive to detect cord presentation. Most suspected cord presentations do not develop into a cord prolapse at delivery. Loops of cord in front of the presenting part can be visualised using colour Doppler studies. This is not routinely done but can be used to examine women serially at high risk.

Prolapse occurring out of hospital has an eighteen-fold risk of mortality. Prematurity and congenital abnormality are underlying factors in most cases. Even congenitally normal, full-term babies can die as a consequence of cord prolapse - home birth and delay in transfer to hospital have been identified as particular risks in these cases [ 2 ].

The most common serious morbidities associated with cord prolapse relate to asphyxia: hypoxic brain injury and cerebral palsy [ 8 ]. There are few long-term studies looking at long-term sequelae of cord prolapse.

Acta Obstet Gynecol Scand. Epub Sep Asahina R, Tsuda H, Nishiko Y, et al ; Evaluation of the risk of umbilical cord prolapse in the second twin during vaginal delivery: a retrospective cohort study. BMJ Open. AJP Rep. Epub May Cochrane Database Syst Rev. Gynecol Obstet Invest. Epub Jul 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.

Firstly, call for help — umbilical cord prolapse is an obstetric emergency. It should be managed as follows:. Fig 2 — The knee-chest position, used in the management of cord prolapse. Firstly, call for help - umbilical cord prolapse is an obstetric emergency. Once you've finished editing, click 'Submit for Review', and your changes will be reviewed by our team before publishing on the site. We use cookies to improve your experience on our site and to show you relevant advertising.

To find out more, read our privacy policy. Pathophysiology Umbilical cord prolapse is where the umbilical cord descends through the cervix, with or before the presenting part of the fetus. Subsequently, f etal hypoxia occurs via two main mechanisms: Occlusion — the presenting part of the fetus presses onto the umbilical cord, occluding blood flow to the fetus. Arterial vasospasm — the exposure of the umbilical cord to the cold atmosphere results in umbilical arterial vasospasm, reducing blood flow to the fetus.

Risk Factors The main risk factors for cord prolapse include: Breech presentation — in a footling breech, the cord can easily slip between and past the fetal feet and into the pelvis. Clinical Features and Differential Diagnosis Cord prolapse should always be considered in the presence of a non-reassuring fetal heart rate pattern and absent membranes. Management Firstly, call for help — umbilical cord prolapse is an obstetric emergency. It should be managed as follows: Avoid handling the cord to reduce vasospasm.

Manually elevate the presenting part by lifting the presenting part off the cord by vaginal digital examination. Alternatively, if in the community, fill the maternal bladder with ml of normal saline warmed if possible via a urinary catheter and arrange immediate hospital transfer. Encourage into left lateral position with head down and pillow placed under left hip OR knee-chest position.

This will relieve pressure off the cord from the presenting part. Consider tocolysis e. It may be sufficient to allow enough time for transfer to a location where delivery is feasible e. This is a particularly useful strategy if there are fetal heart rate abnormalities while preparing for a C-section. Delivery is usually via emergency Caesarean section If fully dilated and vaginal delivery appears imminent, encourage pushing or consider instrumental delivery.