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Umbilical Cord Prolapse

By

Julie S. Moldenhauer

, MD, Children's Hospital of Philadelphia

Last full review/revision Jul 2021| Content last modified Jul 2021
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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

  • Occult: Contained within the uterus

  • Overt: Protruding from the vagina

Both are uncommon.

Occult prolapse

In occult prolapse, the cord is often compressed by a shoulder or the head. The only clue may be a fetal heart rate pattern (detected by fetal monitoring) that suggests cord compression and progression to hypoxemia (eg, severe bradycardia, severe variable decelerations).

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

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 of overt prolapse 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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Options for pain management during normal delivery include regional, local, and general anesthesia. Of these types of anesthesia, which of the following is a safe and simple method for uncomplicated spontaneous vaginal deliveries in women who wish to bear down and push?
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