Umbilical Cord Prolapse & Compression Injuries
Normally, the baby exits the mother before the umbilical cord. In an umbilical cord prolapse, the umbilical cord comes out before the baby. This can happen when the mother’s ‘water breaks’ before the baby has moved into the birth canal. 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, with recommendations stating that they should occur less than 12 minutes from the onset of signs of fetal distress.
What happens during a cord prolapse?
In a normal delivery, the baby exits the mother before the umbilical cord. Sometimes, however, a situation called umbilical cord prolapse occurs. This means that the umbilical cord drops through the cervix into the vagina before the baby. It often occurs at the same time as the rupture of the amniotic sac (mother’s water breaking), as the baby is moving into the birth canal for delivery.
Prolapsed cord is considered an obstetrical emergency because the cord can become compressed between the baby’s body and the uterus, cervix, or pelvis during delivery. If this occurs, the oxygen and blood to the baby can be partially blocked or completely cut off and the baby must be delivered immediately.
Video: Cord Prolapse
In this video, nurse Andrea Shea demonstrates an umbilical cord prolapse:
Umbilical Cord Prolapse: Types
There are two types of umbilical cord prolapse:
- 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. They include:
- 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 the baby. The cord can then become compressed as the baby descends.
- Premature delivery.
- Delivery of multiples (twins, triplets, etc.). The first baby may push out the cord of another baby upon exiting the mother.
- Abnormally long cord.
- Excessive amniotic fluid (polyhydramnios). 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.
- Unusual delivery presentation. This would include a breech position where the baby comes through the birth canal feet first, allowing space for the cord to slip through before the feet.
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. This can also be a sign of other equally serious delivery problems and requires immediate attention from medical staff.
Treatment for umbilical cord prolapse
Once a prolapse is diagnosed, it requires rapid delivery. 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.
It is important for the emergency C-section to happen quickly. If the delivery is not prompt, there is the potential that the fetus’ oxygen and blood supply will be diminished or completely interrupted. This may result in brain damage or death. According to “Obstetrics: Normal and Problem Pregnancies,” 5th edition by Steven G. Gabbe, research indicates that permanent brain damage occurs rapidly when oxygen is completely cut off. When asphyxiation occurs for 7-12 minutes, motor and behavioral changes occur with some scarring of the brain. In cases where there is a lack of oxygen for 12-17 minutes, severe neurological damage occurs, often resulting in death. Therefore, the recommendation is for delivery to occur in less than 12 minutes from the onset of the heart rate decelerations to avoid permanent damage.
Cord presentation before cord prolapse
A cord presentation (also known as a funic presentation) occurs when the umbilical cord presents before the baby. Cord presentation can be identified during routine prenatal care using color Doppler tests. 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.
While the membranes are unruptured, a funic presentation does not present a problem as the cord floats freely in the amniotic fluid. However, when the mother’s ‘water breaks’ and the amniotic fluid rushes out, a cord presentation can become a cord prolapse and potentially result in severe oxygen deprivation in the baby. Often, this means that medical professionals will recommend a planned C-section to prevent the baby from getting injured.
Who is at risk for umbilical cord prolapse?
Risk factors for cord presentation include:
- Amniotomy (also known as Artificial Rupture of Membranes)
- Manual rotation of the fetal head
- Fetal malpresentation
- Polyhydramnios (an excess of amniotic fluid)
- Low birth weight
- Marginal cord insertion from the caudal end of a low-lying placenta
- Uterine fibroids or adhesions
- Congenital uterine anomalies
- Cephalopelvic disproportion
- Multifetal pregnancy (twins, triplets, etc.)
- Long umbilical cord
- Placenta previa
Trusted Legal Help for Umbilical Cord Prolapse, Birth Injury, and HIE
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. Reiter & Walsh, P.C. was established to focus exclusively on birth injury cases. Since the firm’s inception in 1997, our legal team has addressed the special 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 in Detroit, Michigan, our attorneys handle cases all over the United States. We’ve handled birth injury cases in Michigan, Ohio, Washington D.C., Pennsylvania, Tennessee, Arkansas, Mississippi, Texas, Wisconsin, and more. Our birth injury team is also equipped to handle cases involving military medical malpractice and federally-funded clinics.