Cord Prolapse

Overview of the umbilical cord

The umbilical cord is a flexible, tube-like structure that, during pregnancy, connects the fetus to the mother. The umbilical cord is the baby’s lifeline to the mother. It transports nutrients to the baby and also carries away the baby’s waste products. It is made up of three blood vessels – two arteries and one vein.

Definition

Umbilical Cord Prolapse is an emergency condition where the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. It is an obstetric emergency during pregnancy or labor that imminently endangers the life of the fetus. Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. The cord can then become trapped against the baby’s body during delivery. An umbilical cord prolapse presents a great danger to the fetus. During the delivery, the fetus can put stress on the cord. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.

Frequency

• Cord prolapse occurs in 0.4 – 0.6 % of deliveries.
• It occurs in 1 of 200 pregnancies

Risk Factors

• Fetal malpresentations
• Premature infants
• Multiparous women

Causes

• A fetus that remains at a high station
• A very small fetus
• Breech presentations. The footling breech is more likely to be complicated because the feet and the legs are small and do not fill well the pelvis.
• Transverse lie
• Polyhydramnios – Excessive amniotic fluid
• Premature rupture of the membranes
• Placenta previa
• Intrauterine tumors preventing the presenting part from engaging
• CPD preventing firm engagement
• Multiple gestation – Delivering more than one baby per pregnancy (twins, triplets, etc.)
• Premature delivery of the baby
• An umbilical cord that is longer than usual

Signs of Cord Prolapse

• The umbilical cord seen or felt during a vaginal examination as it pulsates synchronously with fetal heart
• Fetal bradycardia (sustained) with deceleration (variable) during contraction
• Client reports feeling the cord within the vagina

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