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Umbilical Cord Prolapse

Umbilical Cord Prolapse is a rare obstetric complication seen during delivery, when the umbilical cord is delivered before the baby is. It is an emergency, as umbilical cord can be accompanied by the rupture of the amniotic sac that surrounds the baby. When this happens, the baby’s oxygen supply is restricted or cut off completely, and the baby needs to be delivered as soon as possible.

How common is umbilical cord prolapse, and am I at risk for umbilical cord prolapse?

Umbilical cord prolapse is generally rare, but some pregnant women are more prone to it because the following factors:

  • Polyhydramnios, which is a condition where there is more amniotic fluid that is normally present. When the water ‘breaks’, the pressure may force the cord out.
  • A long or tortuous umbilical cord
  • Malpresentation of the fetus eg. Breech delivery
  • Twins, triplets, etc.
  • Multiparity

The risks are also elevated in women who are obese, or have had successive pregnancies without proper spacing between them.

The symptoms of umbilical cord prolapse are not apparent before the woman is close to delivery. The most significant symptom is the umbilical cord being felt or being visible in the vagina before delivery. If fetal monitoring is being done and the baby’s heart rate is below 120 beats per minute, that is also a sign that there is fetal distress, and umbilical cord prolapse should be checked for.

How to diagnose umbilical cord prolapse

The diagnosis is actually much easier than one would imagine. In fact, in a woman with the risk factors like multiple pregnancies, premature rupture or membranes etc, the doctor will anticipate the occurrence. If you have changed health care providers then your gynecologist should be updated on your medical history, so that appropriate measure can be taken during delivery.

Umbilical cord prolapse will be diagnosed after the following:

  1. Physical examination
  2. Pelvic examination to locate the cord in the vagina
  3. Heart rate monitoring of the mother and the baby

Mortality rate and risk minimization

The complications and mortality rate associated with umbilical cord prolapse are as high as 15%, even in an equipped hospital setting. To prevent fetal death due to asphyxia or blood supply being cut off, immediate management is needed.

The option of immediate vaginal delivery still carries the risk of fetal asphyxiation in the birth canal, so nowadays most practitioners prefer to opt for emergency Caesarian section instead of vaginal delivery.

The pregnant woman is made to lie in a knee-elbow position called Trendelenburg position, so that the baby can be guided out of the pelvic inlet back, which reduces some of the pressure on the cord, reducing the chances of brain damage, asphyxiation and death. The baby is then delivered by emergency C-section.

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