The signs, causes, and how to manage umbilical cord prolapse

It is an immediate concern for every pregnant woman to know the cause, signs, and management of umbilical cord prolapse.

The umbilical cord is a flexible, tube-like structure that, during your pregnancy, connects the fetus to you. It is the baby’s lifeline to the mother.

Also, it transports nutrients to your baby and it carries away your baby’s waste products. It has a composition of three vessels: two arteries and one vein.

Before or during labor, the umbilical cord can drop towards the dilated cervix into the vagina ahead of your baby. This complication is an umbilical cord prolapse, which affects 0.1 to 0.6% of births.

You need to deal with cord prolapse quickly so the fetus won’t put pressure on the cord, cutting off oxygen. It is a medical emergency that may put your baby at a greater risk of disability or even death.

It is always essential to know what pregnancy complication we might be dealing with so that we can resolve it immediately. We will talk about umbilical cord prolapse, its causes, signs and symptoms, and its prevention.

What is an umbilical cord prolapse?

Umbilical cord prolapse is when the umbilical cord suddenly drops (prolapses) between your baby’s presenting part and the cervix into the vagina. It is the abnormal position of the cord in front of the fetus. It causes the fetus to compress the cord, which may result in hypoxemia.

Additionally, it occurs during or before the delivery of the baby. There is an overall report of cord prolapse incidents which have approximately ratio of 1 to 300 births.

If you experience the prolapse of the umbilical cord while in the hospital,  you may likely go into an emergency cesarean delivery. The doctors will do the C-section if you aren’t delivering vaginally already, in an attempt to save your baby’s life.

Types of cord prolapse

The prolapsed umbilical cord can be of two types: the occult and the overt. These two conditions are uncommon.

• Occult prolapse 

  – the umbilical cord descends alongside the presenting part, but not beyond it.

In occult prolapse, the cord is always compressed by a should or the head. The only clue might be a fetal heart rate pattern (using fetal monitoring) that shows cord compression or progression to hypoxemia.

Changing the pregnant mother’s position can relieve pressure on the cord. However, if the abnormal fetal heart rate pattern prolongs, an emergency cesarean delivery is necessary.

• Overt prolapse 

  – the umbilical cord descends past the presenting part and is lower than it in the pelvis.

Overt prolapse happens with ruptured membranes and is more common with breech presentation or a transverse lie. This may also occur with vertex presentation, specifically if membranes rupture (spontaneously or iatrogenic) before engaging the head.

Treatment of overt prolapse begins with slowly lifting the presenting part and a succession of holding the prolapsed cord. This process may restore blood flow while having immediate cesarean delivery.

You may do the knee-to-chest position while having a terbutaline 0.25 mg IV once. It will help you in reducing the contractions.

• Cord presentation 

  – the presence of the umbilical cord between the presenting part and the cervix. This may happen with or without intact membranes.

While the incidence is relatively low, the mortality rate for babies is high (9.1%). This is solely because cord prolapse happens more frequently in preterm or premature babies, who are often breech and may have congenital defects.

Signs and symptoms of a cord prolapse

Most umbilical cord prolapses may happen shortly after the membranes have ruptured.

In a study reviewed by Healthline.com, there is an estimated of 57% of prolapses occur within 5 minutes after the membranes have ruptured, and 67 percent occur within 1 hour after rupture.

There are minimal signs and symptoms when your umbilical cord prolapses. Even so, it is important that you know them well.

• When you are at your home – you may feel your umbilical cord in your vagina after your water breaks.
• When you are at the hospital – your doctor or midwife can detect cord prolapse when they check you manually, or if your baby has an abnormal heartbeat.

How is cord prolapse diagnosed?

If you are at the hospital, your doctor can diagnose a prolapsed cord after seeing the cord or feeling it during a vaginal examination.

The second symptom of a prolapsed cord is an abnormality in your baby’s heartbeat rate. Your baby’s body and your the birth canal’s wall might have pinched the prolapsed cored in between.

This pinching may result in a lack of oxygen and a heartbeat that changes suddenly and recurrently. In the reported incidence of 67 percent of cases, the changes in the baby’s heartbeat may be the first sign of an occult cord prolapse type.

An alternative diagnosis might consider the idea of bleeding per vagina or heavily blood-stained liquor with ruptured membranes. This would recommend placental abruption (separation of the placenta from the uterine wall) or vasa praevia (fetal vessels running in fetal membranes next to cervix’s internal).

Early diagnosis can truly save your baby’s life.

What causes a cord prolapse

Common causes of umbilical cord prolapse include the following:

• Premature rupture of membranes.
• preterm or premature labor
• Multiple gestation pregnancy (twins, triplets, etc.)
• Polyhydramnios (excessive amniotic fluid)
• Malpresentation or malposition of the fetus (breech position)

How to prevent cord prolapse

Preventing the umbilical cord to prolapse might be impossible. You cannot predict or prevent it. Most of the time, umbilical cord prolapse is an often unexpected medical tight spot.

However, if you are at an increased risk, you may be advised to go to the hospital. Then, immediate action will follow if your waters break or your labor has started.

Cord prolapse management

First of all, call for help. Umbilical cord prolapse is an acute obstetric emergency that may require immediate baby delivery. The option of delivery is commonly by C-section.

The doctor might relieve cord compression by manually elevating the fetal position part until the doctor performs a cesarean section. This may reduce the risk of fetal oxygen loss.

It should be managed as follows:

• Avoid handling the cord to lower the risk of vasospasm.
• Manually raise the presenting part by elevating it off the cord by vaginal examination. Alternatively, if within the community, fill the maternal bladder with 0.5 Liter of normal saline (warmed if applicable) using a urinary catheter and settle an immediate hospital transport.
• Encourage into left lateral position with head down and a pillow under left hip or let them be in a knee-chest position. This might alleviate pressure off the cord from the presenting part.
• Consider a tocolysis or terbutaline: If delivery is not immediately available this may relax the uterus and stop contractions, relieving pressure off the cord. It might be sufficient to give enough time for location transfer where delivery is possible. This is a specific, useful strategy if there are abnormalities in fetal heartbeat rate while preparing for a C-section.
• Delivery is usually through an emergency Cesarean section
  • If fully dilated and vaginal delivery is approaching, encourage pushing or consider an instrumental delivery.
  • If at the threshold of viability and extreme prematurity, expectant management should be discussed due to significant maternal morbidity with c-section at this gestation and poor fetal results.

What to do if cord “prolapse” at home

If you are at home and you think or feel that your umbilical cord prolapsed, go to the hospital or call an emergency quickly. You can take some pressure off your umbilical cord by getting your hands and knees with your pelvis up and your head down.

While you are on the way to the hospital by car or ambulance, change your position in various ways. Lie on your back and keep your hips raised. Then, lie on your side, rolled forward toward your stomach with your chest down and your left leg bent, elevated on a pillow. Confirm with your doctor about these positions.

Remember, mommies should know very well about this particular complication. This can be unexpected mostly but keep in touch with your doctor or health care unit as soon as possible if this condition occurs.

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