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Umbilical Cord Prolapse

by Julie S. Moldenhauer, MD

Umbilical cord prolapse is abnormal position of the cord in front of the fetal presenting part, so that the fetus compresses the cord during labor, causing fetal hypoxemia.

The prolapsed umbilical cord may be contained within the uterus (occult) or may protrude into the vagina (overt). Both are uncommon.

In occult prolapse, the cord is often compressed by a shoulder or the head. A fetal heart rate pattern that suggests cord compression and progression to hypoxemia (eg, severe bradycardia, severe variable decelerations) may be the only clue. Changing the woman’s position may relieve pressure on the cord; however, if the abnormal fetal heart rate pattern persists, immediate cesarean delivery is necessary.

Overt prolapse occurs with ruptured membranes and is more common with breech presentation or a transverse lie. Overt prolapse can also occur with vertex presentation, particularly if membranes rupture (spontaneously or iatrogenically) before the head is engaged. Treatment begins with gently lifting the presenting part and continuously holding it off the prolapsed cord to restore fetal blood flow while immediate cesarean delivery is done. Placing the woman in the knee-to-chest position and giving her terbutaline 0.25 mg IV once may help by reducing contractions.

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