Umbilical cord prolapse

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Umbilical cord prolapse is an obstetric emergency during pregnancy or labour that endangers the life of the fetus. It occurs when the umbilical cord presents itself outside of the uterus while the fetus is still inside. It can happen when the water breaks – with the gush of water the cord comes along. Usually, thereafter the fetus will engage and squash the cord, cutting off oxygen supplies and leading to brain damage of the fetus, or stillbirth. Before that happens, the baby must be delivered quickly by caesarean section. In the meantime, the woman adopts the knee-elbow position, and an attendant reaches into the vagina and pushes the presenting part (usually the head) back in so that it does not suffocate the cord. It is useless to try to push the cord back in.

The mortality rate for the fetus is given as 11-17%^[1]. This applies to hospital births or very quick transfers in a first world environment. One series is reported where there was no mortality in 24 cases with the novel intervention of infusing 500ml of fluid by catheter into the woman's bladder, in order to displace the presenting part of the fetus upward, and to reduce compression on the prolapsed cord.

Risk factors

Potential predisposing risk factors include:

• Premature rupture of the amniotic sac
• polyhydramnios (having a large volume of amniotic fluid. The cord may be forced out with the more forceful gush of waters.
• long umbilical cord

References

1. ^ http://www.gpnotebook.co.uk/simplepage.cfm?ID=1785397303 GP Notebook. Mortality 11-17%.