The prolapsed umbilical cord may be
Occult: Contained within the uterus
Overt: Protruding from the vagina
Both are uncommon.
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 Cesarean Delivery Cesarean delivery is surgical delivery by incision into the uterus. Up to 30% of deliveries in the US are cesarean. The rate of cesarean delivery fluctuates. It has recently increased, partly... read more is necessary.
Overt prolapse occurs with ruptured membranes and is more common with breech presentation Breech presentation Fetal dystocia is abnormal fetal size or position resulting in difficult delivery. Diagnosis is by examination, ultrasonography, or response to augmentation of labor. Treatment is with physical... read more or a transverse lie Transverse lie Fetal dystocia is abnormal fetal size or position resulting in difficult delivery. Diagnosis is by examination, ultrasonography, or response to augmentation of labor. Treatment is with physical... read more . 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.