Presentation and Prolapse of The Umbilical Cord

• Umbilical cord prolapse is a complication that occurs prior to

or during delivery of the baby. In a prolapse, the umbilical
cord drops (prolapses) through the open cervix into the
vagina ahead of the baby. The cord can then become trapped
against the baby’s body during delivery.
 There are three clinical types of abnormal descend of the umbilical
cord-

• Occult prolapse: The cord lies alongside but not in front 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 lies in front of it in the intact bag of membranes

• Cord prolapse: The cord lies in front of the presenting part inside the
vagina or outside the vulva following rupture of the membranes.
Incidence
-about 1 in 300 deliveries
- in higher parities
Predisposing Factors
Malpresentations

• The commonest malpresentations associated with cord

prolapse is transverse followed by breech.
• In this situation, the degree of compression will be less than
with a cephalic presentation, but there is still a danger of
asphyxia.
• Face and brow presentation are less common causes of cord
prolapse.
Prematurity

• The size of the fetus in relation to the pelvis and the uterus
allows the cord to prolapse.

• Babies of very low birth weight, less than 1500 gm, are
particularly vulnerable.