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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).

Overt prolapse

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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