Umbilical cord prolapse

Background

  • Occurs in 0.5% of pregnancies
  • Likely secondary to the presenting fetal part not filling enough of the lower uterus and allowing cord to present first during labor.[1]

Risk factors

    • Low birth weight[1]
    • Multiparity[1]
    • Fetal malpresentation[1]

Clinical Features

Umbilical cord prolapse cord in the vaginal canal (red arrow).
  • Presentation of umbilical cord before fetal delivery (can be felt as pulsatile structure on exam)

Differential Diagnosis

Emergent delivery and related complications

Evaluation

  • Clinical diagnosis

Management

Image of knee-chest position.
  • Emergent OB/Gyn consult
  • Do NOT attempt to reduce cord
  • Elevate presenting fetal part to reduce compression and transport to OR for emergent C-section[2]
    • Examiner who diagnosed umbilical cord prolapse must maintain umbilical decompression until patient is in OR
  • Place patient in knee-chest position and encourage not to push or cough[1]
    • May also consider Trendelenburg position (if patient can tolerate) to let gravity assist in moving fetus off pelvic floor

Disposition

  • Admit to L&D

See Also

External Links

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Mercado J, Brea I, Mendez B, et al. Critical obstetric and gynecologic procedures in the emergency department. Emerg Med Clin North Am. 2013 Feb;31(1):207-36.
  2. ↑ Holbrook BD. Umbilical cord prolapse. Obstet Gynecol Clin North Am. 2013 Mar;40(1):1-14.
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