Umbilical cord prolapse is a rare but serious obstetric emergency where the umbilical cord descends from the uterus before the baby. The cord, which delivers oxygen and nutrients, can become compressed, potentially leading to oxygen deprivation for the baby. Prompt recognition and action are necessary.
Understanding Cord Prolapse
Cord prolapse occurs when the umbilical cord slips past the baby’s presenting part after the membranes have ruptured. The danger stems from the cord being squeezed between the baby and the mother’s pelvis or uterine wall, which can significantly reduce or cut off blood flow and oxygen to the baby.
There are two types of cord prolapse. “Overt prolapse” is when the cord is visible outside the vagina or can be felt within the vagina. “Occult prolapse” occurs when the cord is compressed between the baby’s presenting part and the uterine wall, but it is not visible or palpable externally. Both scenarios pose a direct threat to the baby’s oxygen supply due to cord compression.
Factors Contributing to Cord Prolapse
Various factors can increase the likelihood of cord prolapse, primarily those that prevent the baby’s presenting part from engaging in the pelvis. Premature rupture of membranes can create an opportunity for the cord to slip down. Prematurity and low birth weight also contribute, as smaller babies may not fill the pelvic space adequately. Excessive amniotic fluid, known as polyhydramnios, provides more room for the cord to move and can lead to it being “washed” down when membranes rupture.
Abnormal fetal positions, such as breech presentation (feet or bottom first) or a transverse lie (sideways), increase risk because the presenting part does not block the cervix effectively. Multiple pregnancies also present a higher risk, particularly for the second twin, due to increased space and potential for malpositioning. Medical interventions, such as artificially rupturing membranes when the baby’s head is not engaged, can also inadvertently create conditions for a prolapse.
Recognizing Cord Prolapse
Recognizing cord prolapse often involves observing specific signs that indicate the cord has descended. The most direct sign is the sudden appearance of the umbilical cord in the vagina or outside the vulva after the water has broken. In such cases, the cord may be visible or felt by the mother.
Even if the cord is not visible, a sudden, severe, and sustained deceleration in the baby’s heart rate, detected during fetal monitoring, is a significant indicator of potential cord compression. This change in heart rate signals a possible reduction in oxygen supply to the baby. A healthcare professional confirms the presence of the cord through a vaginal examination if cord prolapse is suspected.
Immediate Medical Response
When cord prolapse is suspected or confirmed, immediate medical intervention is necessary due to the severe threat to the baby’s oxygen supply. The primary objective is to relieve pressure on the umbilical cord to restore blood flow to the baby. Healthcare providers will often manually elevate the baby’s presenting part away from the cord by inserting a hand into the vagina.
Changing the mother’s position can also help, such as placing her in a knee-chest position or a steep Trendelenburg position (head-down, feet-up) to use gravity to move the baby away from the cord. Minimizing handling of the cord itself is important to prevent further spasms of its blood vessels. In some situations, filling the maternal bladder with saline using a catheter can help elevate the baby and relieve cord compression.
While these immediate measures are taken, urgent preparation for an emergency delivery, most often a cesarean section, begins. A cesarean section is the safest and quickest method to deliver the baby and prevent prolonged oxygen deprivation. A vaginal delivery is considered only if birth is imminent and safe, with continuous monitoring of the baby’s heart rate. Prompt and coordinated action by the medical team is to improve outcomes for the baby.