Cord prolapse is a rare but potentially dangerous complication that can occur in late pregnancy and labor.
This article looks at what cord prolapse is, how to prevent it, and treatment for when it occurs.
Umbilical cord prolapse
Let’s start with the definition of umbilical cord prolapse so we know exactly what we are talking about.
Essentially, it’s when the umbilical cord descends through your cervix alongside or past the presenting part of the baby.
This usually happens when your waters break or rupture (but not always).
During labor, normally your baby’s head is the presenting part. This is called cephalic presentation. Your baby is head down with the chin tucked and the crown of the head is the presenting, or first, part to be born.
The head fits snugly against your cervix and nothing can get past it that shouldn’t – such as the umbilical cord.
Very rarely, though, the umbilical cord slips past the presenting part. This is called umbilical cord prolapse.
What’s it called when the cord is wrapped around the baby’s neck?
Umbilical cord prolapse is not the same thing as the cord being wrapped around the baby’s neck. This is called a nuchal cord.
You can read more about it in Nuchal Cord – 9 Facts About A Cord Around Baby’s Neck.
What does a cord prolapse feel like?
If you aren’t in hospital, the only way you’ll know the cord has prolapsed is if you see, or feel, a short piece of the cord protruding from your vagina. This is only possible if your waters have broken.
It’s also very rare if it is your first baby, as first babies tend to engage from around 38 weeks of pregnancy. This means the head is well down in the pelvis and unlikely to let the umbilical cord past.
Another sign of cord prolapse is your baby’s fetal movements have changed.
Cord compression causes severe changes to the baby’s heart rate and this can cause movements to slow or stop.
If you notice any changes to your baby’s movements, seek immediate medical assistance.
Cord prolapse symptoms
The first sign of cord prolapse is usually seen as a sudden and severe change in the fetal heart rate. This is because the compression of the cord interrupts the blood flow from the placenta to your baby.
If you’re in the hospital, your health care provider will immediately suggest a change in position to try to resolve the fetal heart rate changes.
If cord compression or cord presentation is suspected, a vaginal examination is done to feel for the presenting part. If the cord is felt it means cord prolapses are causing pressure on the cord.
Cord prolapse management
If you aren’t in hospital and you think your cord has prolapsed, call an ambulance immediately.
While you’re waiting:
- Move into a knee-chest position on the floor, with your bottom higher than your shoulders, to take the baby’s weight off your cervix. Stay in this position until the ambulance arrives
- If the cord is protruding out of your vagina, gently push it back in. This helps keep the cord warm and moist, which prevents the blood vessels from spasming
- It isn’t recommended that anyone uses fingers to keep the baby’s head off the cord, unless it is a health professional who knows how to deal with this emergency.
If the cord slips down through the cervix during labor and you’re in hospital, your care provider will place fingers inside your vagina, and gently push the baby’s head away from the cord.
To reduce pressure, you will be moved into a position that elevates your bottom, such as on hands and knees with pelvis up and head down.
You’ll also be given oxygen. Your baby needs to be born very quickly to prevent lack of oxygen. If the baby is low enough, your care provider might use either forceps or a vacuum; otherwise, you will need a c-section.
What is the risk of cord prolapse?
Fortunately, cord prolapse is a very rare occurrence. Studies show the overall incidence is reported at 0.1%–0.6%.
Cord prolapse occurs, or is more likely to happen, with babies not in a head-down position, multiple gestations, and premature babies.
Cord prolapse risk factors
There are certain pregnancy complications that increase the risk of prolapsed cord:
- Polyhydramnios. Too much amniotic fluid can cause the baby to float above the cervical rim, allowing the cord to slip below the baby’s head
- Malpresentation of baby. The optimal fetal position for birth is head down, ensuring the baby’s head covers the cervix. Side lie (transverse) or breech presentation (head up and bottom down) can allow the cord to come through the cervix first.
- Pre-labor rupture of waters. If the baby isn’t engaged and membranes rupture before labor, there is a chance the cord will prolapse with the gush of fluid from the birth canal
- Twins or Multiple gestation pregnancies. Due to the different position of each baby, there’s a risk one will have a low-lying cord
- Induction when baby isn’t engaged. If the baby’s head is not well into the cervix there’s a risk of a prolapsed umbilical cord.
What causes a cord prolapse?
Almost half the causes of umbilical cord prolapse are iatrogenic, meaning they’re the consequences of interventions done during labor.
The most common intervention is AROM or artificial rupture of membranes. This procedure is risky for women who’ve had several babies previously, as the head is usually high.
Rupturing the membranes artificially when the head is not snug against the cervix increases the risk of cord prolapse.
Types of cord prolapse
Doctors divide umbilical cord prolapse into three types:
- Overt cord prolapse. The cord goes through the cervix into the birth canal after the membranes have ruptured
- Funic presentation. A loop of the cord is between the fetal presenting part and the cervix
- Occult prolapse. The cord is alongside the presenting part but can’t be seen or felt by your care provider; it can be with intact or ruptured membranes.
What is the difference between cord prolapse and cord presentation?
Umbilical cord prolapse means the cord has passed through the cervix into the vagina before the presenting part of the baby.
Cord presentation is when the cord is ahead of the presenting part of the baby but hasn’t passed through the cervix. This is also known as funic presentation (see above).
Cord prolapse treatment
Cord prolapse is a medical emergency, and requires immediate action to prevent fetal distress, birth asphyxia, brain damage, and cerebral palsy.
Immediate action is taken to monitor your baby’s heart rate while preparing you for emergency c-section.
You will be given oxygen, via a face mask or nasal cannula, and encouraged to continue slow deep breathing to prevent hypoxia.
A fetal monitor (CTG) will be positioned to monitor decelerations and contractions of your uterus. An IV line will be started to administer intravenous fluid before and during surgery.
Complications of cord prolapse
The diagnosis of a prolapsed cord is a life-threatening emergency, as the umbilical cord can become squashed or compressed and cut off the flow of blood and oxygen to the baby.
This causes changes in your baby’s heart rate and fetal distress. For most babies, there is no long-term harm if the cord prolapse is diagnosed early and treated immediately.
Prolonged cord compression can result in birth asphyxia, brain damage, and cerebral palsy, if the time between diagnosis and birth is too long. The mortality rate for untreated cord prolapse is high.
Outcomes of cord prolapse
How severely an umbilical cord prolapse will affect the baby will depend on how much pressure was on the cord, and the length of time the cord was compressed.
If the cord was partially compressed then it’s likely the baby will be born without any problems. Full compression reduces blood flow and oxygen to the baby and, if not detected in time, can lead to severe brain damage or death.
It’s a rare complication of birth and the incidence has decreased over the years. There have been significant advances in the management of umbilical cord prolapse which has led to improved birth outcome.
How to prevent a cord prolapse?
It’s scary to think of the things that can go wrong in labor but it’s important to be aware and know what you can do to avoid this happening.
There are certain things you can do to reduce the risk of the umbilical cord being compressed by your baby’s head:
- Avoid having your waters broken, especially if you’re not in labor and your baby’s head isn’t fully engaged. Babies can pop out of the pelvis even when they’re engaged, so it’s best to wait until nature determines when labor should begin
- Avoid cervical checks during pregnancy and labor, because of the risk of accidental rupture of membranes
- If your baby needs to be born early, discuss with your care provider the risks of prolapse associated with any induction methods suggested
- Be aware of optimal fetal positioning to ensure your baby is in a perfect position for birth. Spinning Babies is a fantastic resource for this
- Understand certain conditions, such as excessive amniotic fluid, come with a higher risk of cord prolapse, and be prepared.