Prolapsed Umbilical Cord

What is a prolapsed cord?

A prolapsed cord occurs when the baby's umbilical cord falls into the birth canal ahead of the baby's head or other parts of the baby's body. Another term for this condition is cord prolapse.

A prolapsed cord is a serious emergency and can be very harmful to the baby. When the cord is compressed or squeezed (for example, between the baby and the wall of the uterus or vagina), the baby's supply of blood and oxygen is cut off. The lack of oxygen (birth asphyxia) can lead to severe brain damage or death if the problem is not taken care of within minutes.

How does it occur?

A cord prolapse is not a common occurrence. It happens most often in the following situations:

• when an excessive amount of amniotic fluid is present in the bag of waters (called polyhydramnios)
• during delivery of the second baby of twins
• when the baby is lying sideways in the uterus, not head or bottom down (called transverse lie)
• when the baby is in breech position (head up in the uterus)
• when the bag of waters breaks spontaneously or when the doctor ruptures the membranes during a vaginal exam before the fetus descends into the pelvis
• when a baby is born early (prematurely).

What are the symptoms?

The mother cannot feel if the baby's cord is prolapsed. The problem becomes apparent when the fetal heart monitor, which is usually attached to the mother's abdomen, shows that the baby's heart rate has decreased.

How is it diagnosed?

The health care provider will feel in the vagina for the cord.

What is the treatment?

Various situations involving prolapsed cord are treated as follows:

• If the cord is still pulsating (beating) and can be seen or felt in the vagina, the doctor or nurse will hold up the part of the baby that is coming out first. This takes pressure off the cord. Sometimes the mother will be asked to get up on her knees and bend over. To further help take the pressure off the cord, the nurse or doctor will keep a hand in the mother's vagina until the baby is delivered the fastest way possible, usually by emergency cesarean section. The mother will be given oxygen to breathe.
• If the cord is felt through an amniotic sac that has not broken, the doctor will try not to break the bag of waters. The mother will be asked to get into a position that takes pressure off the cord, either on her hands and knees or with her hips elevated. If the prolapsed cord causes the baby's heartbeat to slow, a cesarean section will probably be necessary.
• If the baby is positioned head down and low in the birth canal and the mother's cervix is fully dilated, the doctor may try to get the baby out quickly with forceps or vacuum extractor. If the mother isn't fully dilated and ready to deliver, a cesarean section will be performed as quickly as possible.
• If the baby is breech, the mother is fully dilated, the baby's bottom is about to be delivered, and the mother has delivered a baby before, vaginal delivery may be possible. Otherwise, a cesarean section may be necessary.

How long will the effects last?

If the problem with the prolapsed cord can be solved immediately, there may be no permanent injury. The longer the delay, the greater the chance of permanent brain damage or death for the baby.

How can I take care of myself?

You should try to remain calm and follow the directions of the doctor and nurses.

If you are concerned about this or any other problem with delivery, discuss your concerns and questions with your doctor before you go into labor. This will help you deal with a problem delivery in the safest and calmest way possible.