When you give birth, the baby is delivered first. The umbilical cord then comes out after your baby. In rare cases, the umbilical cord prolapses, which means it falls out from its normal position.
What Does It Mean?
The umbilical cord is your unborn baby’s lifeline. This tube-like structure connects your unborn baby to your placenta. It contains blood vessels that carry blood, which is rich in oxygen and nutrients, to the baby. It also removes waste products from the baby.
Umbilical cord prolapse occurs when the cord drops through the open cervix into the vagina before your baby moves into the birth canal. When this happens, the cord is squeezed between your baby’s body and your pelvic bones. This reduces your baby’s blood supply, leading to loss of oxygen to your baby. If this happens, your baby will need to be delivered immediately to avoid any risks related to reduced oxygen.
Umbilical cord prolapse is uncommon, occurring in about 1 in 1,000 births. It is dangerous for your baby. One study of over 307 cases of umbilical cord prolapses found that 7% of babies died because of it.
Who Is Most at Risk For Umbilical Cord Prolapse?
There are several pregnancy complications that may increase the risk of umbilical cord prolapse.
- If you’re pregnant with more than one baby (such as twins or triplets).
- Preterm labor.
- A baby with a low birth-weight.
- Breech presentation, where your unborn baby’s feet or buttocks are pointed toward the birth canal. In one study, 36.5% of cord prolapse cases were due to breech presentation.
- Too much amniotic fluid, which is the liquid that surrounds your unborn baby (polyhydramnios). This is usually seen on an ultrasound scan.
- When your water breaks before 37 weeks, which means the fluid-filled sac that surrounds your baby breaks before it's supposed to (Preterm rupture of membranes).
Other risk factors include procedures such as when the doctor breaks the amniotic sac (amniotomy), when the insertion of a cervical ripening balloon starts the dilation of the cervix, or during fetal blood sampling, a procedure where a small amount of blood is taken from your unborn baby to check for birth defects.
How Is It Diagnosed?
A prolapsed umbilical cord can be diagnosed at a medical examination. You may feel the cord in your vagina or your health professional may feel it during a vaginal exam.
For some women, the only sign of a prolapsed umbilical cord is that the baby has an unusual heart rate. An unusual heart rate in your unborn baby can occur in up to 67% of prolapsed umbilical cord cases. This happens because the cord is stretched and compressed, slowing down the flow of blood to your baby. This causes sudden drops or changes in your baby’s heart rate.
If you’re not already at the hospital when this happens, call emergency services immediately. While you wait for the ambulance, you may be told to get onto your hands and knees and bend forward to rest your head on the ground and your pelvis up. This will decrease the pressure on the cord.
How Is It Treated?
If the umbilical cord is sticking out of your vagina, the delivery of the baby needs to happen as soon as possible. Experts say that the time between diagnosis and delivery of the baby should be less than 30 minutes. If the woman is in the first or early second stage of labor, a Cesarean section (C-section) is recommended. In some women, depending on the circumstances, vaginal delivery may be faster.
While waiting for surgery, you may be placed in a knee-to-chest position to relieve the pressure on the umbilical cord. The doctor may also insert their hand or fingers into the vagina and gently lift the part of the baby that is compressing the cord.
If there is likely to be a delay before delivery, doctors may fill your bladder with saline solution to help relieve the pressure on the cord.
The longer the delay in treatment, the higher the chance of death or brain damage. When the umbilical cord prolapse happens outside the hospital, the risk of the baby’s death is 18 times more likely than if it happens in a hospital.
Can Umbilical Cord Prolapse Be Prevented?
Umbilical cord prolapse can’t be prevented. It also can’t be predicted. The umbilical cord moves around a lot during pregnancy so an ultrasound can't predict a cord collapse. It can happen in women without any risk factors. But if you’re at a higher risk, your doctor may advise you to be admitted to the hospital, so that they can take immediate action when you go into labor.