What Is Umbilical Cord Prolapse

Introduction

An umbilical cord prolapse occurs when the umbilical cord starts to leave the body via the female’s cervix before the baby has been delivered. This condition can occur before the baby has been delivered or during birth.¹ 

Importance of understanding the condition

Umbilical cord prolapse is a very serious condition, which sadly carries a high risk of death to the unborn baby (foetus).¹ The umbilical cord provides the foetus with a blood supply, keeping them alive by providing their body with essential nutrients, such as oxygen, which are needed for life. However, if the cord exits the body before the baby it can become compressed, and limit the amount of blood reaching the baby. As the blood carries oxygen, with less blood the baby will receive less oxygen, resulting in a condition known as foetal hypoxia.¹

Overview of the article

This article aims to inform about the causes of umbilical cord prolapse, and the risk factors which increase the chance of this occurring. This article will also introduce the symptoms to look out for to spot umbilical cord prolapse early, and how this is diagnosed by a doctor and treated.

Causes and risk factors

Factors contributing to umbilical cord prolapse

There are factors which can increase the risk of an umbilical cord prolapse occurring, and these are listed below:¹

• If you have a preterm rupture of membranes, which is where your waters break without you going into labour before your 37^th week of pregnancy

High-risk pregnancies and their association

High-risk pregnancies include twin pregnancies, where the incidence of umbilical cord prolapse increases for the second twin.¹ Ultimately, pregnancies where you are carrying more than one baby sadly carry a higher risk of umbilical cord prolapse.²

Fetal factors

Fetal risk factors, which can increase the risk of an umbilical cord prolapse include the following:

• The baby is in breech position prior to delivery, meaning that the baby is coming feet first rather than head first
• This is a multiple pregnancy, and this baby is the second twin
• The baby is being delivered prematurely, meaning that the delivery is occurring prior to 37 weeks gestation
• The baby has congenital anomalies
• The baby has a low birth weight, which is less than 2.5 kg

Placenta and amniotic fluid related risk factors

Other risk factors include having a low lying placenta, and too much amniotic fluid surrounding the baby, known as polyhydramnios.

Umbilical cord related risk factors

If the umbilical cord has abnormalities such as being longer than expected, this may increase the risk of an umbilical cord prolapse occurring.

Symptoms and diagnosis

Identifying the signs and symptoms of umbilical cord prolapse

There are signs to look out for which may indicate that you are having an umbilical cord prolapse, which are included below:

• You can feel something in your vagina, which may be the umbilical cord
• You can see the umbilical cord coming out of your vagina
• The baby’s heart rate begins to slow down after your waters break, which is caused by the baby not receiving enough oxygen, as the blood vessels in the umbilical cord (which carry oxygen-rich blood to the baby) are being compressed

Diagnostic methods and tests used by healthcare providers

In order to diagnose an umbilical cord prolapse, a vaginal examination will be performed during labour after there has been a spontaneous rupture of membranes. This is where the foetal membranes break, and the amniotic fluid is released, causing a woman’s waters to break.

This examination will occur if there have been signs that indicate that you have had an umbilical cord prolapse or if a cardiotocograph, which measures the unborn baby’s heartbeat, shows that the baby’s heart rate is slowing down.

If the umbilical cord prolapse is suspected prior to 37 weeks a speculum of digital vaginal examination may take place to diagnose this condition.

Importance of early detection

Doctors and midwives must act fast to diagnose an umbilical cord prolapse, as fast diagnosis and response is key to saving the baby’s life.

Complications and risks

Potential complications for the baby

On a positive note, there are usually no long term complications for your baby if you have suffered from an umbilical cord prolapse. However, in some cases, due to the lack of oxygen reaching the baby’s brain during a prolapse this may result in brain damage, and in some cases even death. The lack of oxygen may also result in other conditions, such as cerebral palsy and hypoxic ischemic encephalopathy.

Long-term consequences

If the baby develops cerebral palsy as a result of an umbilical cord prolapse then sadly this is a lifelong condition. Cerebral palsy encompasses a group of conditions that affect both movement and coordination, and is caused by abnormal development of the brain. Cerebral palsy can result in jerky movements, making the infant appear clumsy as they get older, and they may take longer to reach milestones in their development, such as walking.

Treatment and management

Labour and delivery

If a woman suspects she is having an umbilical cord prolapse she should ring for an ambulance immediately, and position herself into a knee-chest, face down position.

Urgent delivery is recommended for a live foetus, and a caesarean section (C- section) is the advised mode of delivery if the baby cannot be delivered naturally via the vagina immediately. A category 1 C-section should be performed if the baby’s heart rate is abnormal andthere should be an aim to get the baby delivered in 30 minutes or less. If the baby’s heart rate is normal then a category 2 C-section may be performed as an alternative. However, the baby’s heart rate will be monitored continuously throughout this.

How an umbilical cord prolapse is managed

If you are experiencing an umbilical cord prolapse, and are in hospital, you may receive the following:³

• Immediate delivery of the baby, most likely by C-section
• An oxygen face mask
• Funic reduction is rarely used and involves the replacement of the umbilical cord in your uterus
• If delivery is not imminent, and the umbilical cord is seen exiting the vagina, the umbilical cord will be kept moist

Postnatal care debriefing for the mother

As a mother, the experience of an umbilical cord prolapse can be scary, and talking to your midwife, GP or obstetrician may help to discuss what has happened after the birth of the baby. It is possible to suffer from postnatal depression and post-traumatic stress disorder as a result of an umbilical cord prolapse. However, there is plenty of support available to you at your local hospital and community teams. Do not hesitate to reach out for support and talk about the experience before leaving the hospital as this can greatly reduce anxiety about future pregnancies too.

Prevention

Strategies to reduce the risk of umbilical cord prolapse

To our dismay, umbilical cord prolapse can not be prevented and there are no ways of predicting that this will happen.  However, if you have a lot of the presented risk factors and are therefore at a higher risk of having an umbilical cord prolapse you may be admitted to hospital. This will allow the doctors to react immediately if your waters do break and do all that they can to safely deliver the baby.

For example, if the baby is not lying head down ready for birth, and there is a risk of early rupture of the membranes, being admitted to hospital will ensure that you are in the best hands if an umbilical cord prolapse does occur.

Importance of prenatal care and monitoring

Regular check ups and ultrasounds allow conditions such as polyhydramnios to be identified that may be a risk factor for umbilical cord prolapse. In this case further checkups will be required and you may be asked to give birth in a hospital. This ensures that you are in the best hands if a complication such as umbilical cord prolapse occurs.

Case studies and real-life examples

Cases of umbilical cord prolapse

Case 1

A patient experiences an umbilical cord prolapse whilst at home, and was brought into hospital via an ambulance. When she arrived she was examined, and the baby was shown to be in a head first position. However, at first it was thought that the unborn baby had no heartbeat. However, using a technique known as ultra-sonography the baby’s heartbeat was shown to have slowed down remarkably. An emergency C-section was performed and the baby was delivered after 20 minutes. However, after a few hours the baby sadly passed away.⁴

Case 2

A 37 year old patient at 39 weeks of gestation was admitted to hospital with lower abdominal cramps and watery vaginal discharge. Medical history revealed that the patient had previous pregnancies with no complications, and the babies were delivered naturally. When the patient had a vaginal examination the umbilical cord was present. This resulted in an emergency C-section being performed and successful delivery of the baby.⁵

Ultimately all cases are different. However, if you are at high risk of having an umbilical cord prolapse, being admitted to the hospital prior to the birth of your baby,, ensures you and your baby are in the best hands.

Summary

• Umbilical cord prolapse is when the umbilical cord exits the vagina prior to the baby
• The umbilical cord provides the unborn baby with nutrients, such as oxygen
• Umbilical cord prolapse is a serious condition which can result in little oxygen reaching the unborn baby
• If the response to treatment is not quick, this can result in brain defects and sadly even death
• Long-term conditions that umbilical cord prolapse can result in include cerebral palsy