Umbilical Cord Prolapse
Definition
Umbilical cord prolapse is a condition during the last stages of pregnancy in which the umbilical cord descends into the vagina prematurely. This most often occurs after the membranes have ruptured and the baby moves into the birth canal for delivery.
As the baby passes through the vagina during delivery, it puts pressure on the cord, which can decrease or cut off the infant’s blood supply.
Umbilical cord prolapse is a very dangerous condition that can cause stillbirth unless the baby is delivered quickly, usually by cesarean section (C-section). Other complications include infant brain damage from lack of oxygen. Most babies delivered quickly through cesarean section do not suffer from complications caused by this condition.
Umbilical cord prolapse is relatively common, occurring in one in every 300 births.
Umbilical Cord Prolapse
Causes
The most common cause of umbilical cord prolapse is the premature rupture of the membranes containing the amniotic fluid. 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
Risk Factors
These risk factors increase your chance of developing umbilical cord prolapse. Tell your doctor if you have any of these risk factors:
- 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
The symptoms of umbilical cord prolapse include seeing or feeling the umbilical cord in the vagina prior to the baby's delivery. Low heart rate of less than 120 beats per minute is also a symptom that the baby is in distress from umbilical cord prolapse.
Diagnosis
Your doctor will ask about your symptoms and medical history, and do a physical and pelvic exam.
Tests may include the following:
- Heart rate monitoring of the mother and baby
- Pelvic examination to see and feel the umbilical cord present in the vagina
Treatment
Treatment options include:
- Having a C-section—If the baby cannot be quickly delivered vaginally without risk of insufficient oxygen, 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 disrupt 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
Prevention
Umbilical cord prolapse is difficult to prevent. But, if you have risk factors, talk to your doctor about C-section and other ways to help prevent the risk of umbilical cord prolapse.
The American Congress of Obstetricians and Gynecologists
American Pregnancy Association
The Society of Obstetricians and Gynaecologists of Canada
Women's Health
Catanzarite VA. The two-vessel cord: how concerned should we be? Contemporary Ob/Gyn. 1997;43-54.
Collins JH, Collins CL, Collins CC. Silent risk: issues about the human umbilical cord. Pregnancy Institute website. Available at: http://www.preginst.com/silentrisk.pdf. Published June 14, 2002. Accessed December 9, 2009.
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.
Prolapsed umbilical cord. Women's Health Advisor. University of Michigan Health System website. Available at: http://www.med.umich.edu/1libr/wha/wha_proco_crs.htm. Accessed July 4, 2007.
Umbilical cord abnormalities: quick references and fact sheets. March of Dimes website. Available at: http://www.marchofdimes.com/professionals/14332_4546.asp. Accessed July 4, 2007.
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 July 4, 2007.
Last reviewed December 2011 by Ganson Purcell Jr., MD, FACOG, FACPE
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
