Prolapsed cord is a medical emergency which develops before or during childbirth. In this condition the delivery of the fetus is preceded by the exit of the umbilical cord. The following article provides information about the various causes, symptoms, and treatment options available for this condition.
The umbilical cord is the organ which connects the fetus to the placenta. It provides nutrition to the developing fetus. Umbilical cord prolapse occurs when the umbilical cord passes into the vagina in front of the baby’s head. In this condition the cord drops or falls into the open cervix, and reaches the vaginal opening before and during child delivery. As the baby passes through the birth canal during labor, it puts pressure on the cord which may decrease or completely stop the blood and oxygen flow to the baby. This may lead to stillbirth unless the child is delivered quickly.
Causes and Symptoms
The main reason for umbilical cord prolapse is premature tear of the membrane, which holds the amniotic fluid (amniotic sac). Other probable causes are an abnormal presentation of the fetus, abnormally long cord, excess amniotic fluid, premature delivery, or multiple pregnancy. The risk factors for this condition are abnormal placentation, low weight at birth, pelvic tumors, and multiparity.
The fallen cord protrudes in the vaginal opening and can be seen during vaginal examination. In this condition when the fetal heart is monitored with the help of a fetal heart monitor, it shows a decreased heart rate (less than 120 heartbeats per minute). This condition is also known as bradycardia. However, the most concerning issue with this medical emergency is that it may occur without any physical symptoms. Moreover, in some cases the fetal heartbeat is normal. Thus, timely diagnosis of this condition is difficult in some cases.
Diagnosis and Treatment
In case of suspected cord prolapse, the doctor may palpate the pelvic area with his/her fingers to detect the fallen cord. The heart rate of the fetus is monitored for any changes. After confirmation of this condition, therapeutic intervention involves lowering the pressure on the umbilical cord and delivering vaginally as soon as possible to avoid any complications. Nevertheless, practical implementation of both the approaches is not successful in most cases.
The last resort for this condition is delivering the fetus with an emergency C-section (Cesarean section). During the entire procedure, the woman is allowed to remain in Trendelenburg position, i.e., feet orienting in a higher level than the head. The objective is to move away the intestinal portion from the pelvic area by force of gravity. Overall, this reduces pressure to the cord and aids in getting easy access to the pelvic organs. With recent nursing interventions, the mortality rate has been decreased significantly.
In the new treatment method, 500 ml saline is delivered in the woman’s bladder via a catheter. The fluid serves dual purposes in saving the life of the fetus. Firstly, it reduces compression on the cord and secondly, it causes a part of the fetus to move upward for safe delivery. If therapeutic intervention doesn’t work in removing the pressure from the cord, it may cut off oxygen supply to the baby, resulting in brain damage or stillbirth.
It is a rare incidence with an occurrence rate of less than 1 percent. According to medical data, this complication is observed in 1 out of every 300 childbirth cases. The fetus mortality rate is recorded to be 11-17 percent. Successful delivery within a short time is the prime objective to deal with a cord prolapse.