During a normal birth, a baby comes out before the umbilical cord. An umbilical cord prolapse is when that order is reversed, and the umbilical cord comes out before or alongside the baby. This happens in about one in 620 births.
An umbilical cord prolapse is a serious medical emergency with a mortality rate of up to 50%. The umbilical cord may be compressed, blocking the baby’s oxygen and blood flow. It may be necessary to perform an emergency C-section.
The Importance of the Umbilical Cord
The umbilical cord contains two arteries and a vein. It carries oxygenated blood from the placenta to the fetus and carries waste away. When there is pressure against the cord, it gets compressed, and the flow of oxygen is reduced or cut off. The baby has no other way to get the oxygen it needs.
What Happens During an Umbilical Cord Prolapse?
In certain situations, the umbilical cord may fall through the birth canal before the baby. The baby’s head or body may then press against the cord and cut off the baby’s oxygen supply, causing a dangerous low-oxygen condition called “hypoxia.” If this happens, doctors need to make a quick and accurate decision about whether a C-section will be necessary.
If the umbilical cord goes through the cervix into the birth canal sometime before birth, it may not cause problems right away if there is no pressure on the cord. During labor, though, the presenting part of the baby (the part that is coming out first) can press against the cord that had previously descended. At this point, the supply of oxygen becomes restricted, and the baby is in serious danger.
Overt and Occult Umbilical Cord Prolapse
There are two types of umbilical cord prolapse, depending on whether the cord comes out before or alongside the baby.
In overt prolapse, which is the more common type, the cord emerges out of the cervix or the vagina before the baby does. The attending medical professional should be able to see or feel the cord.
In occult prolapse, the cord descends alongside the baby. This may happen with either intact or ruptured membranes.
Causes of Umbilical Cord Prolapse
The most common cause of umbilical cord prolapse is the premature rupture of membranes. If this happens, either on its own or because a doctor deliberately ruptures the membranes during a procedure called an amniotomy, the baby’s head may be high, and the umbilical cord may emerge through the cervix before or alongside the baby. Then, during birth, the cord may become dangerously compressed.
Risk Factors for Umbilical Cord Prolapse
Major risk factors for umbilical cord prolapse are:
- Excessive amniotic fluid, also called “polyhydramnios.” When the fluid leaves the birth canal, the umbilical cord may fall out.
- Preterm birth. When the baby is smaller than usual, the umbilical cord is more likely to move around it.
Other risk factors include:
- Twins or triplets, where one baby may push out the cord of another
- Abnormally long umbilical cord
- Low birth weight
- Deformities of the pelvis or uterus
- Breech or foot-first position
- Prolonged labor
- Baby’s presenting part not engaged
Symptoms of Umbilical Cord Prolapse
Umbilical cord prolapse may be diagnosed before labor using fetal Doppler or ultrasound.
During labor and delivery, signs and symptoms of cord prolapse include:
- Seeing the cord before the baby is delivered
- Feeling the cord before the baby is delivered
- Observing a drop in the fetal heart rate on the fetal monitor, especially when below 110 beats per minute
Treatment for Umbilical Cord Prolapse
When cord prolapse has been diagnosed, doctors must act quickly.
In some situations, one option is an amnioinfusion, where saline solution is infused into the uterus in an attempt to enable the baby to float around the umbilical cord. If this is done, the fetal heart rate must be carefully and continuously monitored.
Sometimes doctors try to deliver the baby vaginally while moving the baby away from the cord. They may use forceps or other delivery tools. Often, this may not work, and the doctors need to perform an emergency C-section immediately.
Doctors may also attempt a vaginal birth by having the mother deliver on her hands and knees.
If the fetal heart rate is low, a C-section must be done quickly. While the mother is being prepared and moved for surgery, a doctor or nurse should hold the baby’s head away from the umbilical cord with their fingers.
Dangers of Not Performing Delivery Quickly Enough
When there is umbilical cord prolapse, delivery of the baby must take place within minutes. This will usually be done by emergency C-section. If doctors wait too long, the baby’s supply of oxygen and blood will be lessened or cut off entirely.
Treatment After Birth
If a baby born with umbilical cord prolapse is non-responsive, it will be necessary to give the baby oxygen and perform CPR. Even if the baby appears fine, doctors should do a thorough examination after birth, and set up follow-up appointments with a pediatrician.
Medical Malpractice and Umbilical Cord Prolapse
Medical professionals have a duty to properly monitor and care for women during their pregnancies, to appropriately diagnose umbilical cord prolapse, to provide the appropriate treatment after prolapse has been diagnosed, to act quickly enough, and to avoid making careless mistakes. A doctor or other medical professional who did not do their duty in a way that met the applicable professional standards may have committed malpractice.
If you believe that you were not treated properly for umbilical cord prolapse, you may be eligible to receive compensation for your baby’s medical expenses, pain and suffering, and loss of future income. The experienced birth injury attorneys at Raynes & Lawn can help. Call us at 1-800-535-1797 for a free and confidential case evaluation.
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