What to Know About Umbilical Cord Prolapse

The baby proceeds through the birth canal ahead of the umbilical cord during a healthy delivery. When the umbilical cord drops from the cervix into the vagina before the baby, this is called umbilical cord prolapse. A prolapsed cord is a potential pregnancy complication because the baby can push on the cord, and this pressure can cut off the baby’s oxygen supply. While this can happen during birth, there is also the possibility of this happening before delivery. This occurrence is a neonatal emergency as this can result in harm and even death to the baby.

A brief overview

Although uncommon, when umbilical cord prolapse does occur, it should be treated as an emergency. Stillbirths can occur as the baby may lack oxygen during delivery. Since the umbilical cord supplies the baby with necessary nutrients, including oxygen, it is imperative nothing happens to block or damage the cord from providing resources to the baby. 

Suppose cord prolapse occurs (diagnosed by seeing the umbilical cord or feeling it during an exam or sometimes when a baby has a low heart rate). In that case, the baby is typically delivered quickly by cesarean section. The health care provider will generally attempt to keep good oxygen flow to the baby by elevating the baby until the c-section can be performed. Besides death, the baby can potentially suffer brain damage or other severe injuries, such as cerebral palsy.

What causes umbilical cord prolapse?

The most common cause of cord prolapse is when the membranes rupture (water breaks) prematurely. Although this is the most common cause, other reasons can be early labor, multiple pregnancies (twins, triplets, etc.), the baby is in a breech presentation, and excess amniotic fluid. Cord prolapse often cannot be predicted. Since it is an obstetric emergency, if the birth parent sees or feels evidence of the umbilical cord, this should be considered a medical emergency. The parent needs to head to the hospital immediately or emergency services/911 contacted.

Who is at risk?

Since cord prolapse cannot be predicted, every pregnant person is potentially at risk for this condition. However, some pregnancies may be at higher risk, such as multiples (twins, triplets, etc.) or pregnancies with pre-term labor or membrane rupture. Since risk factors are small, all pregnant persons should be aware of umbilical cord prolapse and how it could impact their baby.

In some pregnancies, an umbilical cord abnormality may be detected, and if this is found, this may indicate a risk of cord prolapse occurring during birth. Additionally, if a baby is breech (feet downward), this is a potential risk factor. In these cases, the birth parent should be strongly encouraged to deliver in a hospital setting where immediate assistance can be offered should this condition occur.

What are the symptoms?

There are a few symptoms of a prolapsed cord. The main symptom is feeling or viewing the umbilical cord. Besides this, there is a chance the baby may display bradycardia or slowed heart rate. The bradycardia may occur due to the baby receiving decreased oxygen because of the pressure on the umbilical cord. If bradycardia is present shortly after the rupture of membranes, cord prolapse should be a concern, and steps should be taken to determine if it has occurred or not. No test can show if cord prolapse is an issue. It is diagnosed by feeling for the umbilical cord by the healthcare provider. 

How is it treated?

The only treatment for cord prolapse is immediate delivery of the baby. Although typically by c-section, in some cases, vaginal delivery may be quicker and deemed a healthier route. Although this is the only treatment, the birth parent can take some steps if the umbilical cord is detected. The birth parent should head straight to the hospital or contact emergency services. The birth parent can get on all fours with the pelvis up and head down, relieving some pressure off the umbilical cord. If the birth parent is in transit to the hospital, lying on the back and keeping the hips raised, then shifting to lying on the side with chest down and left leg bent, may relieve some pressure.

Education to parents, healthcare personnel, and anyone assisting with pregnancy and birth can help avoid complications for the baby in the event of cord prolapse. As some parents elect to use non-physicians (such as midwives), it is essential that these persons are educated on cord prolapse and the severity in the event it does occur during birth they are overseeing.

Is it preventable?

Unfortunately, cord prolapse is not preventable. Since there are few risk factors, all pregnancies should be monitored for this condition. If cord prolapse occurs, the mortality rate for the baby used to be recorded as high as 47%, but with advances in c-section delivery and overall medicine, the death rate has dropped to less than 10%. When cord prolapse occurs outside of the hospital setting, the risk of death to the baby increases by 20-fold.

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