Umbilical Cord Coming Out Before Baby During Delivery – How Prolapse Is Treated?

Umbilical Cord Coming Out Before Baby During Delivery – How Prolapse Is Treated?

During every normal delivery, the head of the baby comes first, followed by umbilical cord and placenta in the end. However, many births don’t happen like that and the order is inverted when the baby doesn’t come out first. We will discuss one such pregnancy complication in this article.

What is umbilical cord prolapse?

The umbilical cord is the tube-like structure and the lifeline of the baby to the mother. It transfers essential nutrients to the baby and takes away waste product from the fetal body. Umbilical cord prolapse is a pregnancy complication in which before or during the delivery the umbilical cord appears at the cervical outlet before the baby.

The word prolapse means slipping or dropping, hence the umbilical cord is pushed out of the cervix before the baby’s head (as in normal delivery). Prolapse of the umbilical cord is a medical emergency as the baby can push against the cord and block the flow of blood and oxygen. In this case, the baby has to be delivered quickly.

Types of umbilical cord prolapse

The condition can occur in both vertex or cephalic (head first) position as well as breech position (feet or buttocks first). Umbilical cord prolapse can be classified into two types:

Overt umbilical cord prolapse

This is the most common type of prolapse in which the umbilical cord descents or drops before the presentation of the baby. In this situation, the cord descents into the cervix or in some cases, beyond the vagina before the appearance of the baby. This normally happens due to rupture of the membranes.

Occult umbilical cord prolapse 

This type of prolapse occurs when the umbilical cord slides along with the baby. Occult cord prolapse can occur in both the situations; ruptured or intact membranes.

How common is umbilical cord prolapse?

According to estimates, prolapse occurs in 1 out of 300 cases. It is mostly common in multiparous women or women carrying multiple babies. However, the mortality rates have significantly declined due to advanced techniques and c-section delivery option.

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Causes and risk factors of umbilical cord prolapse

There can be several situations that can lead to umbilical cord prolapse. Some of them are mentioned below.

The exact cause is unknown. Moreover, having risk factors doesn’t mean that a woman will face the condition. A risk factor increases the chances of prolapse as compared to a woman without the risk factors.

Symptoms of umbilical cord prolapse

Below are some of the signs and symptoms of umbilical cord prolapse.

  • Sudden decrease in baby’s heart rate
  • Visibility of the umbilical cord during delivery
  • Fetal distress
  • Wrapping of the umbilical cord around fetus body

Complications of Umbilical Cord Prolapse

Since it’s a medical emergency, the baby has to be delivered without delay. Below are some of the complications that can arise from umbilical cord prolapse.

  • Premature labor and delivery
  • Fetal distress
  • Abnormal fetal heart rate
  • Obstruction of blood and oxygen to the baby
  • Brain damage or conditions like cerebral palsy due to lack of oxygen

Diagnosis of umbilical cord prolapse

A doctor can diagnose the condition through several ways. Some of them are mentioned below.

Pelvic examination

The doctor may examine the pelvis and see the prolapsed cord or feel it with the fingers.

Fetal heart monitoring

Prolapse is normally diagnosed during the delivery process by measuring fetal heart rate. For this, the doctor uses fetal heart monitor, a device that measures the heart rate of the baby. If the heart rate is less than 120 beats per minute, it may indicate a prolapse.

Prenatal ultrasound

During the routine checkup before the delivery, the doctor may scan the abnormal position of the umbilical cord through ultrasound.

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Treatment of umbilical cord prolapse

The condition puts the baby at immediate risk, so following methods may be adopted for the safe delivery of the baby. The team of doctors will be able to decide the course of action depending on the case.

  • Changing position of the mother to move the fetus away and reducing the risk of losing oxygen supply.
  • Giving medication (tocolytics) to reduce contractions.
  • Operative vaginal delivery if the condition is diagnosed during the childbirth. Forceps and vacuum extractor can be used to deliver the baby.
  • Elective c-section delivery if the condition is diagnosed before labor.
  • Emergency cesarean delivery is the condition is diagnosed during the labor and delivery.

The longer the delay in treatment, the greater the chance of complications for the baby. So if the treatment is given early, there will be minimal chances of injury to the baby. C-section is considered the safest route.

Is umbilical cord prolapse preventable?

Prenatal routine checkup is the best way to prevent the condition. If you are suffering from polyhydramnios (too much amniotic fluid), then be prepare in advance to face any risks during the delivery. It is vital to note the location of the umbilical cord. If the cord is located abnormally then it can increase the risk of prolapse.

Umbilical cord prolapse could result in dangerous consequences. So, timely intervention and careful monitoring is needed to save the life of the baby. Discuss with your doctor each and every aspect of the risk factors well in advance so that you are better prepared to face the situation.

Sources

1. Peesay M (2017, December ). Nuchal cord and its implications read more
2. Henry E, et al.(2013, March). Neonatal outcomes following a tight nuchal cord read more
3. Miser WF(1992, April). Outcome of infants born with nuchal cords read more
4. Peesay M (2012, August 28).Cord around the neck syndrome read more