The incidence of a prolapsed umbilical cord is one percent or less. This is a condition where the umbilical cord moves between the head of the fetus and the birth canal. The umbilical cord is responsible for transporting nutrients and oxygen to the fetus. Transportation of the nutrients, and more importantly oxygen, is no longer possible with a prolapsed cord. A prolapsed umbilical cord is classified as a medical emergency.
Certain conditions like twins, excessive amniotic fluid (polyhydramnios), breech presentation, an exceptionally long cord (the average length is 22 inches) and a premature fetus with premature rupture of membranes make the possibility of a prolapsed cord more likely. It is important to remember, however, that even the normal physiologic process of spontaneous rupture of the membranes in a term fetus can be associated with a prolapsed cord. Some providers feel so strongly about decreasing the chances of a prolapsed cord that they will not perform artificial rupture of membranes which can also be associated with a prolapsed cord.
There is also a condition known as an occult prolapsed cord. In this situation, the cord will lodge itself between the head of the fetus and the pelvic wall. In contrast to the visually observed or palpated (felt) prolapsed cord, an occult prolapse will not be seen or felt. The diagnosis is first suspected when the fetal heart rate decreases on the fetal monitor or is heard on intermittent fetal auscultation. Changes in maternal position can sometimes alleviate this problem, but the ultimate solution is delivery, either vaginally or by cesarean.
Luckily, as I mentioned previously, cord prolapse does not occur often. The solution to any cord prolapse is to delivery the infant quickly. Often, this means performing an emergency cesarean section. Sometimes, the cord can be reduced by slipping the cord over the infant’s head to allow oxygen to flow again. And if the vaginal delivery is imminent, reducing the cord may eliminate the necessity for a cesarean section.
People will sometimes ask, “What can I do to prevent a prolapsed cord?” Unfortunately, not much. A prolapsed cord is often luck of the draw.
A prolapsed cord demands quick, decisive action. If the vaginal delivery is not imminent, and the cord cannot be reduced, then a cesarean section is the solution. Due to the emergent nature of the case, an operating room crew will be quickly assembled. There are a couple of measures that can temporarily resolve the prolapsed cord while preparations are being made. A nurse or other health professional will place their hand inside the vagina and push the fetal head out of the pelvis so that oxygen can again travel to the fetus. This action can be combined with inserting a foley catheter into the bladder (which is necessary prior to performing the cesarean section anyway as the foley catheter decompresses the bladder and decreases the chances of bladder injury by the operating individual), and filling the foley with normal saline. The distended urinary bladder will help to push the fetal head out of the pelvis. Of course, the foley catheter will be unclamped just prior to the cesarean to allow the bladder to decompress.
The difficult part psychologically for the patient is that she will not get to see her baby being born. Again, as the prolapsed cord is an emergency, the anesthesiologist will use general anesthesia for the cesarean section. Normally, a cesarean section, which is not an emergency, is performed using a spinal anesthetic which allows the mother to see her infant soon after the birth and also allows someone to be present in the room with her for the delivery. A support person is normally not allowed in the operating room when the patient is under general anesthesia.
Under extreme cases of fetal intolerance to the prolapsed cord, the cesarean section may have to be performed using a local anesthetic such as xylocaine. This is a difficult procedure physically and psychologically for the patient as complete numbing of the surgical site is not possible. It is also difficult for the operating provider and for the support staff, such as the nurses, as it is hard to see someone in pain. Fortunately, cesarean sections using local anesthetic are rare.
Wishing you a happy and problem free delivery, Pablo.