From the Guidelines
Umbilical cord prolapse is a serious obstetric emergency where the umbilical cord slips down through the cervix ahead of the baby during labor or after the membranes rupture, requiring immediate medical attention to prevent fetal hypoxia and potential death. This condition can occur in different degrees, including occult, complete, or funic presentation, and is often associated with risk factors such as prematurity, abnormal fetal presentation, polyhydramnios, and artificial rupture of membranes when the fetal head is not engaged 1. The management of umbilical cord prolapse involves immediate interventions, including:
- Positioning the mother in knee-chest or Trendelenburg position
- Manual elevation of the presenting part off the cord
- Oxygen administration to the mother
- Emergency cesarean delivery Healthcare providers may also attempt to relieve pressure on the cord by inserting a hand into the vagina to hold the presenting part away from the cord until delivery, as seen in cases of irreversible causes of fetal distress, such as umbilical cord prolapse with sustained bradycardia 1. Prompt recognition and management are essential to prevent fetal hypoxia and potential death, and a high index of suspicion is necessary to identify specific causes of fetal distress, which may only become evident after delivery 1.
From the Research
Definition and Incidence of Umbilical Cord Prolapse
- Umbilical cord prolapse is a rare occurrence and a life-threatening emergency for the fetus, with an incidence ranging from 1 to 6 per 1000 pregnancies 2, 3.
- It is associated with high perinatal mortality, ranging from 23% to 27% in low-income countries to 6% to 10% in high-income countries 3.
Risk Factors
- Multiple risk factors for umbilical cord prolapse have been suggested, including fetal malpresentation or abnormal lie, prematurity, multifetal gestation, and polyhydramnios 2.
- Women at higher risk of umbilical cord prolapse include multiparas with malpresentation, and other risk factors include polyhydramnios and multiple pregnancies 4.
- Iatrogenic umbilical cord prolapse can occur in procedures such as amniotomy, fetal blood sampling, and insertion of a cervical ripening balloon 4.
Diagnosis and Management
- The diagnosis of umbilical cord prolapse is largely made by examination and found after rupture of membranes, and most often, examination is prompted by fetal heart rate decelerations 2.
- The management of umbilical cord prolapse is expedited delivery, with cesarean section being the delivery mode of choice, but vaginal/instrumental delivery could be tried if deemed quicker, particularly in the second stage of labor 3, 4.
- Measures to relieve cord compression, such as manual elevation of the presenting part and Vago's method (bladder filling), should be attempted if the diagnosis-to-delivery interval is expected to be lengthy 4.
- The knee-chest prone position can be used to relieve cord compression and facilitate spinal anesthesia in emergency cesarean delivery 5.