Prolapsed Umbilical Cord

What is a prolapsed cord?

A prolapsed cord occurs when the baby's umbilical cord falls into the birth canal ahead of the baby's head or other parts of the baby's body. Another name for this problem is cord prolapse.

A prolapsed cord is a serious emergency and can hurt the baby. When the cord is compressed or squeezed (for example, between the baby and the wall of the uterus or vagina), the baby may stop getting blood and oxygen. The lack of oxygen (asphyxia) can cause brain damage or death if the problem is not taken care of within minutes.

How does it occur?

A cord prolapse does not happen often. It may happen when:

• There is too much amniotic fluid in the bag of waters (a problem called polyhydramnios).
• The second baby of twins is being born.
• The baby is lying sideways in the uterus, not head or bottom down (called a transverse lie).
• The baby is in breech position (head up in the uterus).
• The bag of waters breaks before the baby moves down into the pelvis.
• A baby is born early (prematurely).

What are the symptoms?

You cannot feel if the baby's cord is prolapsed. The problem may be found when the fetal heart monitor, which is usually attached to your abdomen, shows that the baby's heart rate is slower or abnormal.

How is it diagnosed?

Your healthcare provider will feel in the vagina for the umbilical cord.

What is the treatment?

The treatment depends on the situation:

• If the cord is still pulsating (beating) and can be seen or felt in the vagina, your healthcare provider will hold up the part of the baby that is coming out first. This takes pressure off the cord. Sometimes you will be asked to get up on your knees and bend over. Your provider will keep a hand in your vagina until the baby is delivered the fastest way possible, usually by emergency C-section. You will be given oxygen to help the baby get more oxygen.
• If the cord is felt through an amniotic sac that has not broken, your provider will try not to break the bag of waters. You will be asked to get into a position that takes pressure off the cord, either on your hands and knees or with your hips raised. If the prolapsed cord causes the baby's heartbeat to slow, a C-section will probably be necessary.
• If the baby is positioned head down and low in the birth canal and your cervix is fully dilated, your provider may try to get the baby out quickly with forceps or vacuum extraction. If you are not fully dilated, a C-section will be done as quickly as possible.
• If the baby is breech, a vaginal delivery may be possible if you are fully dilated, the baby's bottom is about to be delivered, and you have delivered a baby before. Otherwise, the baby may need to be delivered with a C-section.

How long will the effects last?

If the problem with the prolapsed cord can be solved right away, there may be no permanent injury. The longer the delay, the greater the chance of permanent brain damage or death for the baby if the cord is compressed and the baby is deprived of oxygen.

How can I take care of myself?

You should try to remain calm and follow your healthcare provider's directions.

If you are concerned about this or any other problem with delivery, discuss your concerns and questions with your provider before you go into labor. This will help you deal with a problem delivery in the safest and calmest way possible.