Almost always, umbilical cord prolapse is a medical emergency. Delayed intervention can harm the fetus.
What is umbilical cord prolapse?
By medical definition, a prolapsed umbilical cord occurs when, during the birth process or as part of a premature rupture of the membranes (a rupture of the amniotic sac), the umbilical cord shifts so that it is between the birth canal and the unborn baby. Because the pressure on the umbilical cord can cause oxygen deprivation in the fetus, umbilical cord prolapse usually receives emergency medical treatment. Within Germany, umbilical cord prolapse occurs in approximately 0.3% of pregnancies. It mainly affects fetuses with a deviated fetal position; such a deviated fetal position can, for example, take the form of an oblique, foot or transverse position. Umbilical cord prolapse also occurs more frequently in multiple births.
Causes
In medicine, a possible cause of umbilical cord prolapse is a birth canal that is not adequately sealed by the fetus. For example, premature births or fetuses that are smaller than average are at increased risk of having a prolapsed umbilical cord. Other factors that can promote a prolapse of the umbilical cord include a very low placenta (placenta) and/or a so-called hydramnios – the presence of an increased amount of amniotic fluid in the uterus. If a prolapsed umbilical cord occurs as part of a premature rupture of the bladder, the prolapse may be due to the fetus being pulled into the expectant mother’s pelvis by the sudden suction of the amniotic fluid; if the umbilical cord is below the fetus at this time, the unborn child’s body may exert pressure on the umbilical cord and a prolapsed umbilical cord occurs.
Symptoms, symptoms and signs
A prolapsed umbilical cord can be detected by several signs. Usually, the doctor first notices a drop in the embryo‘s heart rate. This causes the baby’s pulse and activity to slow down. On physical examination, the pulsatile umbilical cord can be felt in front of the embryo, and often by this time it has become entangled in the baby’s limbs, torso, or neck. If the umbilical cord is not released immediately, there is acute danger to life. As a result of the lack of oxygen and blood supply, brain cells die after only a few minutes. This often results in severe disability or even death of the child. If the umbilical cord wraps around the fingers or toes, this can lead to fractures and, as a result, malformations. In the case of a prolapsed umbilical cord, a caesarean section must be performed in any case. If this is done in time and the child is still sufficiently supplied with oxygen, there are no late sequelae. However, in individual cases, developmental delays may occur. In addition, a prolapsed umbilical cord usually results in premature birth, which is always associated with certain risks. Externally, a prolapsed umbilical cord cannot be detected. However, mothers often notice that the baby stops moving or suddenly panics.
Diagnosis and course
To diagnose a prolapsed umbilical cord, a procedure called cardiotocography is often performed first; this is a procedure that makes it possible, for example, to check the heartbeat of an unborn child. Indications of umbilical cord prolapse include, for example, a slowed heartbeat of the fetus. If a suspected diagnosis is present, a treating gynecologist often palpates the expectant mother’s birth canal in a next step to determine the position of a possibly prolapsed umbilical cord. If this examination step is still not able to sufficiently confirm a diagnosis, an amniocentesis, for example, is also possible if the cervix is already sufficiently open. The course of an umbilical cord prolapse is positively influenced above all by early medical intervention. If medical intervention is delayed, a prolapsed umbilical cord can lead to damage to the fetus in the course of its development. In severe cases, umbilical cord prolapse may result in the death of the embryo.
Complications
Umbilical cord prolapse is among the most dangerous complications that can occur during childbirth. If the prolapse is not detected in advance during cardiotocography, failure to seek medical treatment or treatment that is too late can, in the worst case, lead to severe damage or death of the child.One sign may be premature rupture of the membranes. In this case, the expectant mother should be taken to the hospital as soon as possible in a lying position. Due to the rupture of the bubble, the amniotic fluid suction pulls the fetus towards the mother’s pelvis. If the umbilical cord happened to be below the baby at that moment, the fetus itself pushes on the prolapsed umbilical cord. The mother can at least reduce the pressure in a lying position. Whenever the umbilical cord prolapses, the oxygen and blood supply to the fetus is interrupted. As a result, the child can either become severely disabled or even die, so an emergency cesarean section is necessary. In the worst case, if the child has already been deprived of oxygen for too long and dies, it must be resuscitated inside the uterus. This works, for example, with bronchodilator drugs. A cesarean section is inevitable in the case of the umbilical cord prolapse, because the umbilical cord makes a natural birth through the vagina impossible.
When should you go to the doctor?
Since a prolapsed umbilical cord is an emergency, immediate action must be taken when it occurs. Otherwise, fetal death will occur during or immediately after delivery. Since normally the expectant mother is in the hands of a medically trained staff, the irregularity will be noticed and treated by the staff. If the pregnant woman notices any peculiarities or abnormalities during the birth process, she should immediately inform the nurses, midwives or doctors present. Although there is constant monitoring of the health of mother and child during the birth process, warning signs or changes communicated by the mother can be clarified and investigated more quickly. In the case of a birth in an inpatient setting, in a birth center, or in the case of a planned delivery in the home, obstetricians are present to a sufficient extent. In the case of a spontaneous birth without the presence of trained personnel, an ambulance should be alerted. Until its arrival, the instructions of the emergency physician should be followed, since in severe cases there is danger to the life of mother and child. For anatomical reasons, a prolapsed umbilical cord cannot be treated by the affected person herself. The expectant mother is dependent on the help of others and can only give them feedback about health changes, abnormalities or irregularities.
Treatment and therapy
In most cases, umbilical cord prolapse requires the rapid performance of a cesarean section. If the expectant mother still needs to be transported to the hospital initially when a prolapsed umbilical cord is present (which may be the case, for example, if the baby’s bladder ruptures unexpectedly), prone transport is often important; in this position, the pressure of the fetus on the prolapsed umbilical cord can be relieved. Also helping to relieve pressure on the prolapsed umbilical cord in the event of cord prolapse is, for example, the emergency medical measure of moving the fetal head, which has advanced into the birth canal, back into the uterus. In addition, the mother-to-be’s pelvis is often elevated until a cesarean section is performed. Supplementary administration of agents that suppress labor activity in the expectant mother (in medicine, these active substances are also known as tocolytics) can prevent the fetal head from pushing out of the uterus again. If a fetus has already suffered a very severe lack of oxygen as a result of a prolapsed umbilical cord, resuscitation (resuscitation) of the unborn child inside the uterus may be necessary in some cases; such resuscitation can be performed, for example, with the help of drugs that cause the bronchi to dilate.
Outlook and prognosis
Umbilical cord prolapse can often be resolved by elevation of the pelvis or lateral positioning of the pregnant woman. Delivery can occur vaginally with monitoring of the baby and is usually successful. If complications arise during or after the cord prolapse, a cesarean section is performed. Medications such as fenoteral may need to be prescribed. The prognosis of umbilical cord prolapse is very good nowadays. In most cases, elevation or lateral positioning is sufficient to allow a natural birth. Nevertheless, a prolapsed umbilical cord means life-threatening danger for the child and possibly also for the mother.The sooner the umbilical cord prolapse is detected and repaired, the better the prospects for a natural birth in which the child is born healthy. If the outcome is positive, the child and mother do not have to expect any late consequences. However, a difficult birth can mean trauma for the mother, which must be worked through with therapeutic support. In principle, there is a prospect of recovery, provided that the birth can be induced as planned and no further adverse events occur. In the case of premature rupture of the membranes, there is a risk that the fetus will die while still in the womb.
Prevention
If premature rupture of the membranes occurs during a stage of pregnancy when the embryo’s head has not yet positioned itself in the pelvis, transporting the baby to a hospital in a prone position can help prevent umbilical cord prolapse in advance. Regular checkups during pregnancy can diagnose any fetal positional abnormalities that may increase the risk of cord prolapse.
Follow-up
In most cases, the measures and options for direct follow-up of umbilical cord prolapse are significantly limited or, in many cases, not even available to the patient. For this reason, a physician must be consulted as early as possible in the case of this condition in order to prevent further damage to the child. In the worst case, this can lead to the death of the child and thus to a stillbirth. The earlier the umbilical cord prolapse is detected and treated, the better the further course of this disease usually is. The symptoms themselves are usually alleviated by a Caesarean section. After such an operation, the mother should in any case rest and take it easy. Efforts or stressful and physical activities should be avoided in order not to put unnecessary strain on the body. Regular checks and examinations are also very important after the birth of the child in order to detect other complaints and damage at an early stage and then treat them. The parents themselves are dependent on the help of their own family in the event of a prolapsed umbilical cord, which can also prevent depression and other psychological upsets in particular.
This is what you can do yourself
The occurrence of a prolapsed umbilical cord can hardly be prevented by the woman in advance, and even when this complication occurs, it is the professional medical help that the pregnant woman and especially the child need. Nevertheless, there are some things that the woman can pay attention to around the umbilical cord prolapse. First and foremost, that is keeping up with regular checkups. Gynecologists can use ultrasound images to assess fit of the baby’s head and placenta, and thus the risk for cord prolapse. Otherwise, it makes sense for a pregnant woman to always consult a doctor or midwife if she has any unclear symptoms. This is especially true for twin pregnancies. The woman can also have the doctor or midwife show her how to feel the pulsation of the umbilical cord and check this in case of doubt. If premature rupture of the membranes has occurred, the risk of umbilical cord prolapse increases rapidly. The pregnant woman can help herself and her baby in these cases by getting into a lying position and elevating the pelvis. The wrong reaction is to get to the clinic quickly by car in a sitting position in order to supposedly save time. Self-help for umbilical cord prolapse is the lying down position. Even in the ambulance, the pregnant woman is then transported to the hospital in the prone position.
