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What is Umbilical Cord Prolapse?
During pregnancy, the umbilical cord delivers oxygen and nutrient-rich blood to your growing baby. Normally, as labour progresses, your baby moves down through your dilated cervix and into the birth canal, coming out first. The umbilical cord follows and is then clamped and cut painlessly. However, umbilical cord prolapse happens when the cord slips ahead of your baby, dropping through the cervix and into the vagina before the baby does. This rare obstetric emergency can compress the cord and cut off your baby’s oxygen and blood supply, leading to serious complications if not addressed immediately.According to a chapter published in The Global Library of Women’s Medicine, the incidence of umbilical cord prolapse is 0.2 per cent or 1 in 500 of all deliveries.
There are two types of umbilical cord prolapse:
- Overt (complete) prolapse: The cord descends past the baby’s presenting part (like the head or feet) and is visible or felt in the cervix or vagina.
- Occult (incomplete) prolapse: The cord slips down alongside the baby’s presenting part but isn’t ahead of it and may not be visible.
Cord Presentation
The cord lies between the baby’s presenting part and the cervix, with or without ruptured membranes. The cord has not moved past the baby yet, but is positioned in front of it.Causes of Umbilical Cord Prolapse
There’s no single cause of umbilical cord prolapse, but a few factors can contribute to this complication. It often happens after your water breaks, as the rush of amniotic fluid can carry the cord downward. A few causes that can lead to this issue are:- Breech presentation: The cord can slip past more easily if your baby is in a footling breech (feet first) or any position other than head-down.
- Multiple pregnancies: Carrying twins, triplets, or more increases the chance due to extra amniotic fluid and movement.
- Polyhydramnios: Too much amniotic fluid allows more room for the cord to move and slip.
- Premature rupture of membranes: If your water breaks before full term, the baby’s presenting part might not be low enough in the pelvis yet.
- Unstable lie: Your baby’s position shifts between breech, transverse, or oblique, making the cord more likely to slip.
- Prematurity: Preterm babies are smaller and may not settle into the pelvis properly.
- Artificial rupture of membranes: The cord may prolapse when a doctor intentionally breaks your water, especially if the baby’s head or body isn’t low in the pelvis.
How Does Umbilical Cord Prolapse Affect Your Baby?
When the umbilical cord prolapses, it can become a serious issue because:- The cord gets squeezed between your baby’s body and your cervix or vagina, blocking blood and oxygen flow.
- Each contraction puts more pressure on the cord, further reducing your baby’s oxygen supply.
- Arterial vasospasm occurs if the cord is exposed to air and narrows because of the cold. This reduces blood flow to your baby.
- Foetal hypoxia: Lack of oxygen can lead to distress, and if untreated, it may cause brain damage, permanent disabilities, or even stillbirth.
Symptoms of Umbilical Cord Prolapse
Recognising the signs of umbilical cord prolapse is crucial, though some cases have no obvious symptoms. Your doctor or midwife will be on the lookout for these clues, especially after your waters break:- A sudden drop in the heart rate, slowing, or abnormal patterns like decelerations (temporary drops in heart rate).
- In overt prolapse, the cord may be seen or felt in the vagina or cervix after the membranes rupture.
- Umbilical cord prolapse typically occurs within minutes to an hour of your water breaking.
How is Umbilical Cord Prolapse Diagnosed?
Your healthcare professional may use several methods to diagnose this issue, including:- Clinical evaluation: Your doctor will ask about your pregnancy history and check your baby’s position through a physical exam.
- Vaginal examination: They may gently examine your vagina to feel for the cord or confirm its position.
- Foetal heart monitoring: Continuous tracking of your baby’s heart rate can reveal distress, like bradycardia (slow heart rate) or frequent decelerations.
- Ultrasound: This imaging test helps assess your baby’s position and amniotic fluid levels.
- Blood pressure check: A sudden change in your blood pressure might also be a clue.
Treatment Options
Your healthcare professional may use several treatments to manage umbilical cord prolapse and protect your baby, such as:- Relieve pressure: Your doctor may manually lift your baby’s presenting part off the cord during a vaginal exam to ease compression.
- Positioning: You’ll be asked to move into the knee-chest position (face down, knees tucked, hips up) or the left lateral position with a pillow under your hip to take pressure off the cord.
- Tocolysis: If delivery isn’t immediate, your doctor may give you tocolytic medication to relax your uterus. This will suppress contractions and reduce pressure on the cord.
Delivery Options
- Emergency caesarean section: The safest option is usually a caesarean section to deliver your baby quickly and avoid oxygen loss.
- Vaginal delivery (rare): If you’re fully dilated and delivery is imminent, pushing or assisted vaginal delivery may be possible.
Differential Diagnosis
Other issues can mimic prolapse, so your doctor will rule out:- Placental abruption: The placenta separates from the uterus, causing bleeding and foetal distress.
- Vasa previa: Foetal blood vessels near the cervix burst and bleed.
- Uterine rupture: A tear in the uterus wall can lead to pain and heart rate changes.
Can Umbilical Cord Prolapse Be Prevented?
Unfortunately, umbilical cord prolapse cannot be fully prevented because the cord and baby move unpredictably during pregnancy and labour. However, you can lower risks by:- Regular prenatal care: Routine check-ups help detect issues like abnormal presentation or excess fluid early.
- Healthy lifestyle: Eat a balanced diet, avoid smoking and alcohol, and manage stress to support a healthy pregnancy.
- Stay informed: Know the signs, like heart rate changes or visible cord, so you can alert your doctor quickly.
FAQs on Understanding Umbilical Cord Prolapse: What to Know Before and During Labour
- How does umbilical cord prolapse affect the baby?
The cord may get compressed between the baby and the birth canal, cutting off the oxygen supply. It can lead to foetal distress, brain injury, or stillbirth if not managed quickly. - What are the signs of umbilical cord prolapse?
Common signs include a sudden drop in the baby’s heart rate after the water breaks, or the cord being visible or felt in the vagina. These signs usually appear within minutes to an hour after membrane rupture.