An umbilical cord prolapse is an obstetric emergency where the cord descends through the cervix into the vagina before the baby’s presenting part. The danger arises because the cord, the baby’s lifeline, can become compressed between the baby and the mother’s pelvis after the amniotic sac has ruptured. This compression severely restricts or cuts off the oxygen and blood supply to the fetus, requiring immediate action to safeguard the baby’s survival. Every minute of cord compression risks serious complications.
Immediate Response: Relieving Pressure and Contacting Emergency Services
The priority upon recognizing a cord prolapse is to relieve pressure on the umbilical cord and simultaneously activate the emergency medical system. The mother must be positioned immediately to use gravity to move the baby away from the cord. The most effective position is the knee-chest position, which involves the mother getting onto her hands and knees with her chest low to the floor and her buttocks raised high into the air.
If the knee-chest position is not possible, an alternative is the exaggerated Trendelenburg position. The mother lies on her back with her hips elevated significantly higher than her head, which can be achieved by placing large pillows or cushions under her hips. The goal of both positions is to shift the baby’s weight off the cord, a maneuver that must be maintained until medical professionals arrive.
While the mother is being positioned, a helper must call the local emergency number, such as 911, without delay. The caller must clearly state that a pregnant person has an “umbilical cord prolapse” and provide the exact location for the fastest response. The helper must remain on the line to receive any further instructions from the dispatcher while the mother maintains the pressure-relieving position.
Actions to Strictly Avoid During the Emergency
Instinctive actions that worsen the situation or introduce unnecessary risk must be strictly avoided. Under no circumstances should anyone attempt to push the exposed umbilical cord back into the vagina or uterus. This manipulation can cause a sudden spasm of the cord’s blood vessels, immediately stopping the flow of oxygenated blood to the baby. Attempting to reinsert the cord also introduces a high risk of infection into the sterile uterine environment.
Another prohibited action is pulling on the cord, as this can cause trauma to the umbilical vessels or the placenta. The helper should also avoid attempting a quick, unassisted delivery at home. The immediate delivery of a baby whose cord is prolapsed requires specialized medical equipment and personnel, typically a cesarean section, to prevent fetal distress.
Do not attempt to drive to the hospital instead of waiting for Emergency Medical Services (EMS). Transferring the mother requires her to maintain the pressure-relieving position, which is often impossible or severely compromised during a car ride. The delay associated with self-transport dramatically increases the risk to the baby.
Managing the Cord and Preparing for Medical Transport
Once the mother is in the correct position and emergency services are en route, attention should turn to managing the exposed portion of the umbilical cord. The cord must be kept warm and moist to prevent the blood vessels from constricting, known as vasospasm, which would cut off the blood supply. A clean, warm, wet towel or gauze soaked in warm saline solution, if available, should be gently applied to the exposed cord.
The helper should minimally handle the cord to reduce stimulation and check for a pulse. Feeling a pulse indicates that blood flow to the baby is still occurring, which is a positive sign. This information should be noted and communicated to the arriving medical team.
The mother must remain in the knee-chest or elevated-hip position without moving until medical personnel arrive and physically take over the task of relieving pressure. When EMS arrives, the mother may be transferred to a more secure position for transport, such as the exaggerated Sims position, a left-sided lie with the hips elevated. The helper should clearly and concisely communicate the situation, including the time the prolapse was first noticed and the status of the cord’s pulse, to ensure a smooth and rapid handover to hospital care.