Doctor’s Notes on Cord Prolapse

When a patient has this condition, the cord protrudes from the vaginal opening or can be felt by the clinician during vaginal examination.

CORD prolapse is an obstetric emergency during pregnancy or labour that highly endangers the life of the baby because of the risk of inadequate supply of oxygen to the foetus. It occurs when the umbilical cord comes out of the uterus while the foetus is still inside.

What causes cord prolapse?
The most common cause of cord prolapse is premature rupture of the membranes that contain the amniotic fluid. Other causes are:

o Multiple pregnancy o Excess amniotic fluid
o Breech delivery—a situation whereby the baby comes out through the birth canal legs first
o An umbilical cord that is longer than usual

What are the signs and symptoms in a patient with that condition?
Generally the mother does not feel that the baby’s cord is prolapsed. When a patient has this condition, the cord protrudes from the vaginal opening or can be felt by the clinician during vaginal examination. If the cord is pulsating, then the foetus is alive. Sometimes it is not felt during a pelvic examination and the only indication may be foetal heart rate changes. In other instances, loops of cord are palpated through the membrane, before rupture of membranes. This is referred to as cord presentation.

How is it detected?
A doctor can diagnose a prolapsed umbilical cord in several ways. During delivery, the doctor will use a foetal heart monitor to measure the baby’s heart rate. If the umbilical cord is prolapsed, the baby may have bradycardia (a heart rate of less than 120 beats per minute). The doctor can also conduct a pelvic examination and may see the prolapsed cord, or feel the cord with his or her fingers.

How is cord prolapse treated?
Because of the enormous risk to the foetus, umbilical cord prolapse must be dealt with immediately. If the doctor finds a prolapsed cord, he will feel to assess whether the cord is still pulsating (beating) and then try moving the foetus away from the cord in order to reduce the risk of oxygen loss. The doctor or nurse will hold up the part of the baby that is coming out first, to take the pressure off the cord. Sometimes the pregnant woman may be asked to get on her knees and bend over, to further help take the pressure off the cord. The nurse or doctor may keep a hand in the mother’s vagina to prevent the baby from pressing the cord which would reduce blood flow; until the baby is delivered the fastest way possible, usually by emergency Caesarean section.

What are the dangers of a prolapsed cord?
A prolapsed cord, as earlier said, is a serious condition with fatal outcomes and can be very harmful to the baby. When the cord is compressed between the baby and the wall of the uterus or vagina for example, the baby’s supply of blood and oxygen is cut off. The resultant lack of oxygen, also known as birth asphyxia, can lead to severe brain damage or death of the baby if the problem is not resolved promptly. If appropriate action is taken immediately, there may be no permanent injury to the baby. However, the more the delay, the greater the chance that problems such as brain damage or death of the baby, can occur.

Are there any dangers for the mother?
There are no dangers presented to the mother because of this condition.

Any special precautions for future pregnancies?
It is not recurrent in subsequent pregnancies therefore no special precautions need to be taken in future pregnancies and births.

END: PG8/11