What is Umbilical Cord Prolapse?
An umbilical cord prolapse is a condition in which the umbilical cord protrudes through the cervix and into the birth canal ahead of the baby. This can cause the cord to become compressed, which can cut off the blood and oxygen supply to the baby and pose a significant risk of fetal hypoxia. Extended periods of fetal hypoxia can lead to brain damage or even death if not addressed immediately.
Umbilical cord prolapse occurs in approximately 1:300 births. The prolapse may be either occult or overt. In an occult prolapse, the cord passes alongside the presenting part of the fetus. This means that it is not visible and cannot be felt upon physical examination. An overt prolapse occurs when the cord passes ahead of the fetus and is visible or palpable within or extruding from the vaginal vault.
Causes of Umbilical Cord Prolapse
Umbilical cord prolapse most often occurs when the water breaks before the baby is in the appropriate position for delivery. This is known as a “premature rupture of membranes,” or PROM. It can also occur when there is too much amniotic fluid, during a breech delivery, when the mother is carrying multiples, during a premature delivery, or when the umbilical cord is unusually long.
Signs of Umbilical Cord Prolapse
The first sign of an umbilical cord prolapse is typically a decrease in the baby’s heart rate as indicated by a fetal monitor. A fetal heart rate less than 120 beats per minute can be a sign of a prolapsed or compressed umbilical cord.
This may be followed up by a pelvic examination where the doctor attempts to visualize or palpate the cord with their fingers. If there is a prolapsed cord, the doctor will try to move the fetus or position the mother in such a way that reduces the risk of oxygen deprivation until the baby can be delivered surgically. The doctor may do this manually by using his or her fingers or hand to lift the baby off of the cord. The mother may also be placed on her hands and knees or with the foot of the bed elevated above her head to allow gravity to relieve the pressure on the umbilical cord.
Although not as common, a technique called “Vago’s Method” may be used. This involves filling the bladder with saline, which puts upward pressure on the baby and alleviates cord compression.
A prompt delivery via an emergency cesarean section is the best way to reduce the risk of fetal brain damage or death.
Emergency Steps for an Umbilical Prolapse
In some instances, the woman may be able to feel that the cord has prolapsed into the birth canal or see it protruding from the vagina. If this happens at home, call 911 or get to the hospital immediately. The mother can help relieve some of the pressure on the cord by getting on her hands and knees. If the cord protrudes from the vagina, try to support it gently with a clean towel.
Preventing Umbilical Cord Prolapse
There is no way to specifically prevent umbilical cord prolapse. The best steps that a mother can take to protect the health of her unborn child are to seek regular prenatal care and to obtain immediate medical help if any she suspects any complications.
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