Umbilical Cord Prolapse occurs when the umbilical cord descends through the cervix alongside or ahead of the presenting part of the fetus. This can lead to cord compression, reducing blood flow and oxygen to the fetus, which can result in fetal distress. It is considered an obstetric emergency that requires prompt management to prevent adverse outcomes.
Clinical Evaluation
Physical Examination: A vaginal examination may reveal the presence of the umbilical cord in the birth canal.
Fetal Monitoring: Continuous monitoring of the fetal heart rate (FHR) to detect signs of fetal distress such as bradycardia (slow heart rate) or variable decelerations.
Imaging Studies
Ultrasound: Can be used to confirm the diagnosis and assess the position of the cord and the fetus. It may also help identify other factors that could predispose to cord prolapse, such as abnormal fetal lie or polyhydramnios (excessive amniotic fluid).
Visible or palpable umbilical cord in the vagina.
Sudden onset of abnormal fetal heart rate patterns, particularly bradycardia or variable decelerations.
Presence of the umbilical cord before or alongside the presenting part during labor.
Maternal reports of feeling the cord during vaginal examination or labor.
Immediate management is crucial to prevent fetal hypoxia and other complications.
Maternal Positioning: Position the mother in a knee-chest position or Trendelenburg position to relieve pressure on the cord.
Manual Elevation: The healthcare provider may use a sterile gloved hand to elevate the presenting part off the cord until delivery can occur.
Oxygen Administration: Provide supplemental oxygen to the mother to maximize fetal oxygenation.
Emergency Delivery: If the cord prolapse is detected in a hospital setting, an emergency cesarean section is typically performed to quickly deliver the baby and reduce the risk of hypoxia.
Continuous Monitoring: Continuous fetal heart rate monitoring to assess the well-being of the fetus during the management of cord prolapse.