Learning objectives
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List risk factors for umbilical cord prolapse.
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Recognize and manage umbilical cord prolapse.
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Participate in constructive team debriefing after cord prolapse.
Umbilical cord prolapse is a condition in which the umbilical cord presents ahead of the presenting part of the fetus. The umbilical cord will typically protrude into the cervix, vagina, or outside of the body. Cord prolapse is considered an obstetric emergency because of the risk of complications including cord compression, umbilical artery vasospasm, and umbilical vein obstruction, all of which lead to the risk of fetal oxygenation compromise.
Risk Factors
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Unengaged presenting part due to maternal or fetal factors
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Fetal malpresentation
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Footling breech—15% risk of cord prolapse
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Complete breech—5% risk of cord prolapse
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Frank breech—0.5% risk of cord prolapse (which is equivalent to cephalic)
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Prematurity
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Low birth weight
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Second twin
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Fetal anomalies
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Polyhydramnios
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Long umbilical cord
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Low lying placenta
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Maternal pelvic deformities
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Uterine tumors or malformations
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Multiparity
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Artificial rupture of membranes with an unengaged presenting part
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Cervical ripening with a balloon catheter
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Induction of labor
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Application of an internal scalp electrode
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Insertion of an intrauterine pressure catheter
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Manual rotation of the fetal head
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Amnioinfusion
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External cephalic version
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Internal podalic version
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Application of forceps or vacuum
Prevention
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Avoid unnecessary obstetric interventions and perform necessary interventions with care
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Awareness of patients at high risk is key to enable prompt diagnosis and management if prolapse occurs
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Patient with antepartum diagnosis of funic presentation should be followed closely until time of delivery. Funic presentation will resolve in many patients with the onset of labor
Diagnosis
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Most commonly presents with an abrupt onset of sustained, severe fetal bradycardia or repetitive, severe variable decelerations in a patient with previous Category I tracing
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Pulsating umbilical cord may be palpated on cervical examination
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Patient may report seeing or feeling an overt cord prolapse
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Diagnosis is made based on visualization or palpation of the umbilical cord ahead of the presenting fetal part
Management ( Fig. 13.1 )
