The umbilical cord functions as a lifeline for the newly forming fetus & connects the fetus to the mother. It transports vital nutrients and oxygen and also functions as a conduit to dispose the baby’s waste products. In some cases the umbilical cord gets compressed during labour contractions. A cord prolapse occurs when the cord slips ahead of the presenting part of the fetus and prolapses into the cervical canal or vagina or beyond. If the cord is squashed for a long time, it leads to a decrease in oxygen and blood flow to your baby and becomes a medical emergency.
The incidence of cord prolapse is about 1 in 300. It is mostly confined to parous women. There are three clinical types of abnormal descent of the umbilical cord by the side of the presenting part. All these are placed under the heading cord prolapse.
- Octal prolapse: The cord is placed by the side of the presenting part and is not felt by the fingers on internal examination.
- Cord presentation: The cord is slipped down below the presenting part and is felt lying in the intact bag of membranes.
- Cord prolapsed: The cord is lying inside the vagina following rupture of membranes.
Anything which interferes with perfect adaptation of the presenting part of the lower uterine segment, disturbing the ball valve action may favour cord prolapse. Associated factors of prolapsed cord are Malpresentations – Breech delivery (the baby comes through the birth canal feet first), Contracted pelvis, Prematurity, Twins, Hydramnios, Placental factor and Latrogenic.
Signs of a cord prolapse include variations in heart rate, especially a noticeable drop, effects on blood pressure, and lowered oxygen levels. If the cord slips down into the vagina, you may actually be able to feel it or even see it. If the cord is compressed by the baby’s head, the baby will show signs of fetal distress on a fetal monitor. Umbilical cord compression can be diagnosed before labor by one of two doctors test; either a fetal Doppler or an ultrasound.
There are certain things you can do to reduce the risk of umbilical cord being compressed
- Avoid having your waters broken, especially if you’re not in labour and your baby’s head is not fully engaged. Babies can pop out of the pelvis even when they are engaged, so it is best to wait until nature determines when labour should begin.
- Cervical checks during pregnancy can be avoided, 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. An elective c-section might be a safer option.
- 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 that certain conditions, such as excessive amniotic fluid, come with a higher risk of cord prolapse, and be prepared.
How is an umbilical cord prolapse managed?
Treat a prolapsed cord as an acute obstetric emergency. If the doctor finds a prolapsed cord the doctor shall move the fetus away from the cord in order to reduce the risk of oxygen loss.
In some cases, the baby will have to be delivered immediately by cesarean section. Permanent injury can be avoided, if the problem with the prolapsed cord can be solved immediately. However, the longer the delay, the greater the chance of problems (such as brain damage or death) for the baby.
Being aware of the risks and ways to avoid a prolapse will help you feel more confident about what to do if you are at risk of umbilical cord prolapse.