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Prolapsed Umbilical Cord

By Julie S. Moldenhauer, MD, Associate Professor of Clinical Obstetrics and Gynecology in Surgery, The Garbose Family Special Delivery Unit;Attending Physician, The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia;The University of Pennsylvania Perelman School of Medicine

Prolapse of the umbilical cord means that the cord precedes the baby through the vagina.

A prolapsed umbilical cord occurs in about 1 of 1,000 deliveries. When the umbilical cord prolapses, the fetus’s body may put pressure on the cord and thus cut off the fetus’s blood supply.

This uncommon complication may be obvious (overt) or not (occult).

Overt prolapse

The membranes have ruptured, and the umbilical cord protrudes into or out of the vagina before the baby emerges. Overt prolapse usually occurs when a baby emerges feet or buttocks first (breech presentation). But it can occur when the baby emerges head first, particularly if the membranes rupture prematurely or the fetus has not moved down into the woman’s pelvis. If the fetus has not moved down, the rush of fluid as the membranes rupture can carry the cord out ahead of the fetus.

If the cord prolapses, cesarean delivery must be done immediately to prevent the blood supply to the fetus from being cut off. Until surgery begins, a nurse or doctor holds the fetus’s body off the cord so that the blood supply through the prolapsed cord is not cut off.

Occult prolapse

The membranes are intact, and the cord is in front of or next to the fetus or trapped in front of the fetus’s shoulder.

Usually, occult prolapse can be identified by an abnormal pattern in the fetus’s heart rate. Changing the woman’s position usually corrects the problem. Occasionally, a cesarean delivery is necessary.