Umbilical Cord Prolapse & Compression Injuries

Normally, the baby exits the mother before the umbilical cord. In an umbilical cord prolapse, the umbilical cord slips ahead of the fetus and moves into the cervical canal, vagina, or comes out of the birth canal before the baby (1). This is an obstetrical emergency because the cord is at high risk for compression, blocking oxygen and blood flow to the baby. In these cases, an emergency C-section is often necessary (2). Cord prolapse occurs in about one in every 620 births (3).

Umbilical Cord Prolapse and Compression


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Video: Cord Prolapse

In this video, our in-house nurse Andrea Shea demonstrates an umbilical cord prolapse:

Types of umbilical cord prolapse

There are two types of umbilical cord prolapse (1):

  • Overt prolapse: This is the most common type of cord prolapse. It happens when the cord comes out of the cervix or vagina before the presenting part of the baby and is either visible or able to be felt by the medical practitioner.
  • Occult prolapse: This happens when the cord descends alongside, but not past, the presenting part of the baby. It can happen with ruptured or intact membranes.

What causes a cord prolapse?

There are several causes of umbilical cord prolapse. These include (1):

  • Premature rupture of the membranes (PROM): This is the most common cause. If membranes rupture early, or a physician artificially ruptures the membranes (a procedure referred to as an amniotomy), the baby’s head may be high up in the uterus, allowing the umbilical cord to emerge through the cervix before or alongside the baby. The cord can then become compressed as the baby descends (1). In cases where PROM occurs before 32 weeks, cord compression (not necessarily resulting from prolapse) occurs 32-76% of the time (2).
  • Prematurity: Premature infants have a higher risk of malpresentation and tend to be smaller (meaning there is a higher volume of amniotic fluid in relation to the baby’s size).
  • Multiples (twins, triplets, etc.): The first baby may push out the cord of another baby upon exiting the mother.
  • Abnormally long cord
  • Low birth weight
  • Low lying placentation
  • Pelvic deformities
  • Prolonged labor
  • Unengaged presenting part
  • Uterine malformations
  • External fetal anomalies
  • Polyhydramnios (excessive amniotic fluid): When there is a large volume of fluid, the cord can be forced out before the baby due to the pressure of the fluid exiting the mother.
  • Malpresentation

Signs and symptoms of cord prolapse

The most obvious symptom of a prolapsed umbilical cord is seeing or feeling the cord before the baby is delivered. Fetal distress from lack of oxygen can also be observed as a sudden and prolonged fetal heart rate deceleration on the fetal monitor (bradycardia) (1). This can also be a sign of other equally serious delivery problems and requires immediate attention from medical staff.

Umbilical cord prolapse and compression can be diagnosed before labor by ultrasound or fetal Doppler (2). These issues can also be diagnosed during labor by touching the umbilical cord and by monitoring fetal heart rate.

Treatment for umbilical cord prolapse

prolapsed umbilical cord; cord prolapse; umbilical cord; vacuum extractor; ventouse; baby; delivery; vaginal delivery

Once a prolapse is diagnosed, it requires rapid delivery (1). In some cases, a physician will try to move the baby away from the cord in order to relieve the pressure and reduce the risk of oxygen deprivation while attempting to deliver the baby vaginally, sometimes with the help of forceps or a vacuum extractor. Often this course of action doesn’t work, and an emergency C-section is performed immediately. Generally, while the mother is prepared for the surgery, the presenting part of the baby is pushed back into the pelvis to continue to relieve the pressure from the cord.

If the delivery is not prompt, cord compression and prolapse can have severe effects on the fetus. When the cord becomes compressed, the fetus’s oxygen and blood supply is diminished or cut off (1). This can lead to neonatal hypoxia, hypoxic-ischemic encephalopathy (HIE), and brain injury (2). It is imperative that delivery occur in minutes, usually by C-section (4).  

Cord presentation before cord prolapse

A cord presentation (also known as a funic presentation) occurs when the umbilical cord presents before the baby (1). Cord presentation can be identified during routine prenatal care via fetal Doppler or ultrasound (2). Usually, a cord presentation before 32 weeks gestation is not a problem – if it persists after 32 weeks, medical professionals should examine the underlying cause and take precautionary measures.

Often, a funic presentation means that medical professionals will recommend a planned C-section to prevent the baby from getting injured (1).


Has your child suffered brain damage from a lack of oxygen during delivery? Do you believe it was due to medical mismanagement of a prolapsed cord? If so, we encourage you to contact a law firm with experience in these types of complex cases. ABC Law Centers  was established to focus exclusively on birth injury cases. Since the firm’s inception in 1997, our legal team has addressed the needs of our clients in a variety of birth injury, pregnancy, and newborn medical malpractice cases. Our attorneys and in-house medical staff determine the causes of our clients’ injuries, the prognoses of birth-injured children, and areas of medical negligence. While we’re based near Detroit, Michigan, our attorneys handle cases all over the United States. Our birth injury team is also equipped to handle cases involving military medical malpractice and federally-funded clinics.


Sources:

  1. Bush, M., Eddleman, K., & Belogolovkin, V. (n.d.). Retrieved February 23, 2019, from https://www.uptodate.com/contents/umbilical-cord-prolapse
  2. Umbilical Cord Prolapse: Causes, Dangers and Treatment. (2015, November 30). Retrieved February 23, 2019, from http://americanpregnancy.org/pregnancy-complications/umbilical-cord-prolapse/
  3. WhattoExpect. (2018, November 15). Cord Prolapse During Pregnancy. Retrieved February 23, 2019, from https://www.whattoexpect.com/pregnancy/pregnancy-health/complications/cord-prolapse.aspx
  4. Siassakos, D., Hasafa, Z., Sibanda, T., Fox, R., Donald, F., Winter, C., & Draycott, T. (2009). Retrospective cohort study of diagnosis-delivery interval with umbilical cord prolapse: The effect of team training. BJOG: An International Journal of Obstetrics & Gynaecology,116(8), 1089-1096. doi:10.1111/j.1471-0528.2009.02179.x