Complication of pregnancy where the umbilical cord slips out of the uterus prior to birth
Medical condition
Umbilical cord prolapse
Other names
Cord prolapse, prolapsed cord[1]
Cord prolapse, as depicted in 1792
Specialty
Obstetrics
Risk factors
Abnormal position of the baby, prematurity, twin pregnancy, multiple prior pregnancies[2][3]
Diagnostic method
Suspected based on a sudden decrease in baby's heart rate during labor, confirmed by seeing or feeling the cord in the vagina[4]
Differential diagnosis
Abruptio placentae[2]
Treatment
Rapid delivery, usually by cesarean section.[4]
Prognosis
Risk of death of the baby 10%[2]
Frequency
< 1% of pregnancies[4]
Umbilical cord prolapse is when the umbilical cord comes out of the uterus with or before the presenting part of the baby.[2] The concern with cord prolapse is that pressure on the cord from the baby will compromise blood flow to the baby.[2] It usually occurs during labor but can occur anytime after the rupture of membranes.[1][5]
The greatest risk factors are an abnormal position of the baby within the uterus and a premature or small baby.[2] Other risk factors include a multiple pregnancy, more than one previous delivery, and too much amniotic fluid.[2][3] Whether medical rupture of the amniotic sac is a risk is controversial.[2][3] The diagnosis should be suspected if there is a sudden decrease in the baby's heart rate during labor.[4][2] Seeing or feeling the cord confirms the diagnosis.[4]
Management focuses on quick delivery, usually by cesarean section.[4] Filling the bladder or pushing up the baby by hand is recommended until this can take place.[4] Sometimes women will be placed in a knee-chest position or the Trendelenburg position in order to help prevent further cord compression.[2] With appropriate management, the majority of cases have good outcomes.[4]
Umbilical cord prolapse occurs in about 1 in 500 pregnancies.[2] The risk of death of the baby is about 10%.[2] However, much of this risk is due to congenital anomalies or prematurity.[2] It is considered an emergency.[4]
^ ab"Umbilical Cord Prolapse". DynaMed. 30 November 2018. Retrieved 10 October 2019.
^ abcdefghijklmLore, Marybeth (March 2017). "Umbilical Cord Prolapse and Other Cord Emergencies". The Global Library of Women's Medicine. doi:10.3843/GLOWM.10136.
^ abcSayed Ahmed, WA; Hamdy, MA (2018). "Optimal management of umbilical cord prolapse". International Journal of Women's Health. 10: 459–465. doi:10.2147/IJWH.S130879. PMC 6109652. PMID 30174462.
^ abcdefghiHolbrook, BD; Phelan, ST (March 2013). "Umbilical cord prolapse". Obstetrics and Gynecology Clinics of North America. 40 (1): 1–14. doi:10.1016/j.ogc.2012.11.002. PMID 23466132.
^"Umbilical cord prolapse in late pregnancy" (PDF). 2015. Retrieved 12 October 2019.
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