• Umbilical Cord Prolapse

    Definition

    The umbilical cord connects the fetus to the placenta (organ that provides nutrition). Umbilical cord prolapse occurs when the umbilical cord passes through the birth canal and into the vagina in front of the baby's head. It occurs after the membranes have ruptured.
    As the baby passes through the birth canal during labor, it puts pressure on the umbilical cord. This compression of the umbilical cord decreases or can completely cut off blood flow and oxygen to the baby.
    Umbilical cord prolapse is a dangerous condition that can cause stillbirth unless the baby is delivered quickly, usually by cesarean section (C-section). Most babies delivered quickly through cesarean section do not suffer from complications caused by this condition.
    Umbilical cord prolapse is relatively common. It occurs in one in every 300 births.
    Umbilical Cord Prolapse
    Prolapsed Umbilical cord
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Premature rupture of the membranes that contain the amniotic fluid is the most common cause of umbilical cord prolapse. Other common causes include:
    • Premature delivery
    • Multiple births (eg, twins, triplets)
    • Excessive amounts of amniotic fluid (polyhydramnios)
    • Breech delivery (feet first)
    • Abnormally long umbilical cord
    • Artificial rupture of membranes (amniotomy)

    Risk Factors

    Risk factors that increase your chance of getting umbilical cord prolapse include:
    • Having a baby that is in the breech position
    • Premature rupturing of the membranes
    • Having multiple births in one pregnancy—The second baby delivered is at greater risk.
    • Having an unusually long umbilical cord
    • Having too much amniotic fluid in the membranes around the fetus

    Symptoms

    Seeing or feeling the umbilical cord in the vagina before the baby's delivery is a symptom of umbilical cord prolapse.

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. A pelvic examination will be done to see and feel the umbilical cord present in the vagina.
    Your doctor may have heart rate monitoring done for you and your baby.

    Treatment

    Treatment options include:
    • Having a C-section—If the baby cannot be quickly delivered vaginally, then the baby will be delivered by C-section.
    • Removing pressure from the cord—In some cases, the doctor may be able to move the baby away from the cord so as not to cut off oxygen supply to the baby. The mother may also be asked to move into a position that removes pressure from the cord and protects the baby.
    • Rapid delivery—If the mother is ready to deliver, the doctor may try to deliver the baby very quickly using forceps or a vacuum extractor.
    Cesarean Delivery
    Cesarean Delivery
    Copyright © Nucleus Medical Media, Inc.

    Prevention

    Umbilical cord prolapse is difficult to prevent. If you have risk factors, talk to your doctor about C-section and other ways to help prevent the risk of umbilical cord prolapse.

    RESOURCES

    The American Congress of Obstetricians and Gynecologists http://www.acog.org/For%5FPatients

    American Pregnancy Association http://www.americanpregnancy.org/

    CANADIAN RESOURCES

    The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

    Women's Health http://www.womenshealthmatters.ca/

    References

    Catanzarite VA. The two-vessel cord: how concerned should we be? Contemporary Ob/Gyn . 1997;43-54.

    Cunningham FG, et al. Abnormalities of the umbilical cord in: Williams Obstetrics . 21st ed. New York, NY: McGraw-Hill; 2001.

    Dildy GA, Clark SL. Umbilical cord prolapse. Contemporary Ob/Gyn . 1993;23-31.

    Lee W, et al. Vasa previa: prenatal diagnosis, natural evolution, and clinical outcome. Obstet Gynecol . 2000;95(4):572-576.

    Levy H, Meier P, Makowski E. Umbilical cord prolapse. Obstet Gynecol. 1984;64(4):499-502.

    Umbilical cord prolapse. The Cleveland Clinic Health Information Center website. Available at: http://www.clevelandclinic.org/health/health-info/docs/3800/3870.asp?index=12345 . Accessed December 19, 2012.

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