Umbilical Cord Prolapse: A Review of the Literature

Abstract

Importance Umbilical cord prolapse is a rare occurrence and is a life-threatening emergency for the fetus. These events are unpredictable and unpreventable. Umbilical cord prolapse requires swift diagnosis and management for optimal outcome. Objective The aim of this review is to describe the incidence, risk factor, pathophysiology, diagnosis, and management of this rare but potentially life-threatening event. Evidence Acquisition A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched. Results There were 200 articles identified, with 53 being the basis of review. Multiple risk factors for a umbilical cord prolapse have been suggested including fetal malpresentation or abnormal lie, prematurity, multifetal gestation, and polyhydramnios. The diagnosis is largely made by examination and found after rupture of membranes, and most often, examination is prompted by fetal heart rate decelerations. The management of umbilical cord prolapse is expedited delivery; however, there are rare specific scenarios in which immediate delivery is not possible and efforts should be made to relieve cord compression. Conclusions Rapid identification of an umbilical cord prolapse facilitates management and increases likelihood of an optimal outcome. The management is an expedited delivery with efforts to relieve cord compression until delivery can be achieved. Relevance Umbilical cord prolapse is a rare but a life-threatening obstetrical emergency. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After completing this activity, the learner should be better able to evaluate published literature regarding umbilical cord prolapse; assess patients for potential risk factors; identify this obstetrical emergency promptly; and devise treatment and follow-up recommendations for optimal patient outcomes.

Umbilical Cord Prolapse—Interesting CTG Traces

“…There are several well-known risk factors associated with cord prolapse, such as obstetrical interventions (artificial rupture of membranes (ARM), if the presenting part is mobile or high [ 3 ]), external cephalic version with spontaneous rupture of membranes, and induction of labor with transcervical balloon catheters [ 4 ]. Other risk factors include fetal malpresentation, unstable lie, preterm labor, or polyhydramnios [ 5 ].…”

Umbilical cord prolapse: are maneuvers always necessary to relieve cord compression?

“…In 1 review, the rate of bradycardia or severe fetal heart rate abnormalities ranged from 41% to 67%. 2 In Wong's previous publication of 114 cases of cord prolapse, they found 29.8% of fetuses with bradycardia, 26.3% of fetuses with fetal heart rate decelerations without bradycardia (typically with a good outcome), and 43.9% of fetuses with no fetal heart rate abnormality. 3 If the lack of engagement of a presenting fetal part increases the risk of cord prolapse, it likely reduces the chance of cord compression by that same presenting part.…”