Q: What is an umbilical cord prolapse?
A: An umbilical cord prolapse occurs when the umbilical cord, which connect
the baby to the placenta, slips before the baby's presenting part close
to (occult prolapse) or into the vagina.
An umbilical cord prolapse affects about 1 in 300 births. If it happens, the baby can put pressure on the cord as he passes through the cervix and vagina during labor and delivery, reducing or cutting off his oxygen supply.
When umbilical cord prolapse happens, the baby needs to be delivered as quickly as possible in the safest and most expeditious way. Umbilical cord prolapse can result in stillbirth unless the baby is delivered promptly, usually by cesarean section. Babies who are delivered promptly are usually unharmed.
If a pregnant woman’s membranes rupture outside of the hospital, and she feels something in her vagina, she should have someone take her to the hospital immediately or call 911.
A doctor may suspect that a woman in labor in the hospital has umbilical cord prolapse if her fetus develops heart rate abnormalities before or after the membranes have ruptured. The doctor can confirm that the cord has prolapsed by doing a pelvic examination. This is an emergency situation, and the doctor will take steps to relieve pressure on the umbilical cord by lifting the presenting fetal part away from the cord while preparing the woman for prompt cesarean delivery.
Occasionally, if a woman’s cervix is fully dilated, she may be able to deliver vaginally.
The following situations increase the risk of umbilical cord prolapse:
- The baby is in a breech (foot or butt first) position
- The baby is premature.
- Second twin vaginal delivery
- Small baby
- Ruptured membranes when the baby is not in the pelvis
In many of these cases, the baby’s presenting part (the foot or a smaller than-normal head) does not fill the pelvis and allows the cord to slip.
Umbilical cord prolapse is more common when:
- The umbilical cord is too long,
- There is too much amniotic fluid
- The membranes rupture before the baby enters the pelvis
- In vaginal twin deliveries, with the second twin most commonly affected