Umbilical Cord Prolapse – An Overview

During birth, the mother delivers the baby head first, which is followed by the umbilical cord and then the placenta. However, not all births happen in the same order. Sometimes, situations may arise when the position of the baby is inverted or when the baby doesn’t deliver first. One of these conditions is an umbilical cord prolapse which can put the baby in a lot of distress.



What Is An Umbilical Cord Prolapse?

An umbilical cord prolapse takes place when the umbilical cord of the baby is pushed out of the cervix before the baby’s head does, as opposed to the usual order of delivery. This causes the baby to push against the cord on the way out blocking the flow of oxygen and blood, resulting in a critical condition for the baby. It is vital that the baby is delivered quickly to prevent any mishap in such cases.





Overt umbilical cord prolapse is when the cord pushes out ahead of the baby and occult umbilical cord prolapse is when the cord slides alongside the baby. Both cause the cord to get blocked posing complications to the baby.

How Common Is It?

Umbilical cord prolapse occurs approximately in one out of every 300 births. However, the mortality rate due to the condition has gone down considerably due to the feasibility of Caesarean delivery options and due to advancement in neonatal care and resuscitation.




Causes

There may be several causes for the condition. Some of the reasons of prolapsed umbilical cord are,

  • Premature Rupture Of the Membranes (PROM): If the membranes rupture too early, or in case the membrane is artificially ruptured by the doctor, then due to the baby’s head being high up in the uterus, the cord may go through the cervix first. As the baby follows, the umbilical cord tends to get compressed.
  • Delivering multiple babies: If a mother is having twins or more, the baby that deliver first may push out the umbilical cord.
  • Excessive amniotic fluid: If the mother has a lot of amniotic fluid, which is a condition known as polyhydramnios, the pressure of the fluid rushing out may push the umbilical cord out.
  • Breech in the position: If there is a breech in the position of the baby, the baby may come feet first, which may provide enough leeway for the umbilical cord to slide through the birth canal.
  • Breech Position Vs. Normal Position
  • Abnormally long umbilical cords may also pose the threat of a prolapse.
  • Premature delivery: The smaller size of the foetus paired with added volume of amniotic fluid can cause the cord to slip out.

Symptoms

A few pronounced signs of umbilical cord prolapse include,





  • Visible umbilical cord during delivery or the doctor feeling the cord during delivery.
  • Foetal distress due to lack of oxygen
  • Decrease in the foetal heart rate for a long duration

Diagnosis

Following are the common methods of diagnosing an umbilical cord prolapsed

  • An overt umbilical cord prolapse, in which the cord is usually visible past the vagina during the time of delivery, is done through a vaginal examination.
  • Occult umbilical cord prolapse, where the cord is being pushed out with the baby simultaneously, is hard to diagnose. However, a Doppler ultrasound imaging is used. This may further delay the delivery posing a risk to the baby. Foetal heart rate deceleration is taking into consideration, and a C-section delivery is performed instead. Occult umbilical cord prolapse is also responsible for foetal bradycardia cases that appear to have no explanation.

Risks of Cord Prolapse

The risks of umbilical cord prolapse to the baby are,




  • Lack of oxygen supply to the brain resulting in brain damage and conditions like cerebral palsy.
  • Bradycardia or abnormally slow heart rate and functioning.
  • Tangled cord around the baby resulting in delivery complications that can be fatal.

Risk factors

There are many risk factors that cause complications of cord prolapse during delivery. Few of them are

  • Malpresentation or the abnormal positioning of the baby
  • Funic presentation where the umbilical cord is pointing towards the lower uterine segment or the internal cervical opening.
  • Foetal anomalies or abnormality in the development of the foetus.
  • Cord abnormalities when the cord is too long
  • Foetal growth restriction where the foetus is premature or too small for its age
  • Polyhydramnios where there is excess fluid in the amniotic sac.
  • Artificial ROM or when the medical practitioner ruptures the membrane intentionally
  • Amnioinfusion where amniotic fluid is instilled into the amniotic sac to prevent deceleration of fetal heart rate, especially due to oligohydramnios.

Managing Umbilical Cord Prolapse

Treatment and Management

Umbilical cord prolapse puts the baby at immediate risk and these are methods followed as remedies for umbilical cord prolapse.





  • Rapid delivery
  • Emergency C-section delivery
  • Providing oxygen to the mother
  • Changing the mother’s position
  • Providing the mother medications to slow contractions
  • In case the compression of the cord is due to low levels of amniotic fluid, an amnioinfusion is conducted.

Prevention

To lower the risk of prolapsed umbilical cord nursing interventions that may act as risk, the following factors need to be avoided:

  • Rupturing the membrane intentionally or accidental rupture due to cervical checks.
  • Getting the water broken
  • If circumstances demand inducing labour, then discuss with your medical practitioner about any risks involved with the induction methods. Opt for C-section for safer alternatives.
  • If you have any condition like polyhydramnios, prepare in advance for any risks during delivery.

Umbilical cord prolapse could be dangerous for the baby if timely intervention doesn’t take place. Before delivery, discuss with your doctor well in advance about the course of action in case such complications arise.




Also read: New-born Umbilical Cord Care – Everything Parents Need To Know