CORD PROLAPSE
It is one of the obstetric emergencies that need a quick
clinical judgement and good critical decision making to
have a positive outcome for both the mother and fetus.
An umbilical cord prolapse is the protrusion of the
umbilical cord alongside(occult or ahead of the
presenting part of the fetus as shown on the picture
below.
This condition occurs 1 out of 300 births (March of
Dimes, 2007). Cord prolapse in 3% deliveries with
vertex position, 3.7% for breech position.
Umbilical cord compression occurs when the
umbilical cord goes through stretching or applied
pressure during the labor process.
The compression leads to an interruption of the blood
and nutrient flow to the fetus, followed by a heart rate
decrease. Prolapse usually leads to total or partial
occlusion of the cord causing fetal perfusion rapid
deterioration Fetal mortality if the cord compression is
not relieved.
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Signs of umbilical cord compression
● less activity from the baby, observed as a
decrease in movement,
● or an irregular heartbeat, which can be
observed by fetal heart monitoring.
Common causes of umbilical cord compression
● Nuchal cords, true knots, and umbilical
cord prolapse.
How is an umbilical cord prolapse diagnosed?
Umbilical cord prolapse is diagnosed by seeing or
palpating the prolapsed cord on pelvic exam. In addition,
the baby may have an abnormal fetal heart rate known
as bradycardia (a heart rate of less than 120 beats per
minute).
How is an umbilical cord prolapse managed?
Umbilical cord prolapse requires immediate delivery of
the baby. The route of delivery is usually by cesarean
section.
The doctor will relieve cord compression by manually
elevating the fetal presentation part until cesarean
section is performed. This reduces the risk of fetal
oxygen loss.
If the problem with the prolapsed cord can be solved
immediately, there may be no permanent injury.
However, the longer the delay, the greater the chance of
problems (such as brain damage or death) for the baby.
Prevention is the key to managing cord prolapse by
identifying clients at risk:
 Take NOTE: When the presenting part does not fully
occupy the pelvic inlet, prolapse is more likely to occur.

● Bedrest, administer oxygen if ordered.

● Provide emotional support and explanations as
to what is going on to allay the woman’s fears
and anxiety.

Prompt recognition of a prolapsed cord is essential to

reduce the risk of fetal hypoxia resulting from prolonged
compression.

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References:

1.https://my.clevelandclinic.org/health/diseases/12345-
umbilical-cord-prolapse
2. NICE Guidelines: Intrapartum care for healthy women
& babies (Feb.2017)
3. MBRRACE Reports (2017)-references to teamworking,
communication & situational awareness
4.RCOG: Umbilical Cord Prolapse (Green-top guideline
(No.50.Updated 2014
5. PROMPT youtube videos
6.Essentials of Maternity,Newborn and womens health
teaching by Susan Scott Ricci page 636-637.