A Cord Prolapse

What is a cord prolapse?

A cord Prolapse also called an Umbilical Cord Prolapse – or UCP – is a very rare obstetrical emergency which can result in a birth injury or worse – fetal death. A prolapse occurs  when your baby’s umbilical cord descends alongside – or before – his head (or his bottom or feet if breech). Cord prolapse can be life threatening to your baby since blood flow – and therefore oxygen – through his umbilical cord is usually compromised due to cord compression. Yet keep in mind that cord prolapse is very rare and occurs in 0.14 to 0.62 percent of all births. In a study performed at the John Radcliffe Hospital between January 1984 and December 1992, the incidence of cord prolapse was 1 in 426 births or .23%.

 

Cord Prolapse
Picture courtesy of Megan Brust

 

Types of Cord Prolapse

There are three types of cord prolapse:

  • Overt cord prolapse
  • Occult cord prolapse
  • Funic presentation

 

Overt Cord Prolapse

This occurs when your baby’s presenting part – usually her head but could be her feet or bottom – does not fit your pelvis snugly after your membranes have ruptured. In this case, the risk is that her umbilical cord will slip past your baby and present at your cervix or descend into your vagina and as a result cut of your baby’s oxygen supply. This is the most common form of a cord prolapse.

Notes: This is most likely with small babies and/or the artificial rupturing of the membranes (AROM) and therefore even less likely during a homebirth than a hospital birth. Midwives focus on nutrition, therefore prematurity and small babies are less likely with midwives than with OBs. Also, midwives hardly ever rupture your membranes.

An overt cord prolapse is an obstetric emergency. Depending on its duration and degree of compression, fetal hypoxia (asphyxia), brain damage and even death can occur. When a cord prolapse is detected – unless birth is imminent – a c-section will be performed.

Occult Cord Prolapse

An occult cord prolapse occurs when your baby’s umbilical cord lies alongside her presenting part.

Funic Presentation

A funic presentation occurs when your baby’s cord prolapses below her presenting part before the membranes have ruptured. This is very, very rare and the least common.

 

 

Survival Rates for a Cord Prolapse

Remember the John Radcliffe Hospital study mentioned earlier? This study measured main outcome survival rates. This was measured in three ways:

  • by recording the Apgar scores at 1 and 5 minutes after birth
  • by assessing blood gas values on cord blood samples
  • by incidence of major handicap at three years of age

The results? There were six stillbirths and six neonatal deaths. One baby died as a result of birth asphyxia. The uncorrected perinatal mortality rate was 91 per 1000. Of 120 survivors, only one baby was known to suffer from a birth trauma in the form of a major neurological handicap. In conclusion, the study confirmed that a cord prolapse occurs with a relatively stable incidence and that it is also very rare. The researchers also concluded that your baby’s outcome was not as poor as expected and that mortality was predominantly attributable to congenital anomalies and prematurity rather than birth asphyxia.

Note: Prematurity is a major risk factor for a cord prolapse. Most women will not have a homebirth with a premature baby.

 

Risk Factors for a Cord Prolapse

There are mainly two reasons for cord prolapse – both of which can be somewhat preventable: 1) Fetomaternal – “baby-mother” – factors that lead to an inadequate filling of your pelvis by your baby’s presenting part 2) Obstetric interventions

Fetomaternal Factors

1) Fetal malpresentation

Your baby lies in a presentation other than head first:

  • Breech: 3 to 4% of births

Overt cord prolapse occurs in more than 1% breech deliveries:

  • 0.5% Frank breech

This is when your baby’s bottom comes first, and his or her legs are flexed at the hip and extended at the knees (with feet near the ears). 65-70% of breech babies are in the frank breech position.

frank
Picture from found on Google
  • 5% complete breech

It is when your baby’s hips and knees are flexed so that your baby is sitting cross-legged, with her feet beside her bottom.

complete
  • 15% footling breech

It is when your baby’s feet come first, with her bottom at a higher position. This is rare at term but relatively common with premature babies.

footling
  • Kneeling breech

It is when your baby is in a kneeling position, with one or both her legs extended at the hips and flexed at the knees. This is extremely rare.

 

  • Transverse:

A transverse lie is associated with a risk of cord prolapse as high as 20%.

transverse

 

  • Oblique lie:

Your baby is head down but her head is toward your hip and not engaged in the birth canal.

Note: Good size babies have a much harder time laying in odd positions for they have less room to fit. So again, a good diet is very important for your health, your baby’s and also as you can see – labor as well.

 

2) Prematurity

Babies born before 37 weeks. Premature babies have a higher rate of umbilical cord prolapse. This is due to a variety of factors but mainly their smaller size and the increased frequency of malpresentations.

3) Multiple gestation

At term, the risk of a cord prolapse is usually to the second twin. Again this is usually due to smaller babies and an increased probability of malpresentation. However, in well fed mothers low birth weight even with twins does not need to be. Most midwifes will report normal birth weights for twins.

Note: Florence has given birth to two sets of twins. Both sets were born at term (more than 38 weeks – which is normal for her and the same as her singletons). The smallest twin was 7 pounds and the largest 7 lbs 15 oz.

 

4) Multiparity

This means women who have had more than one birth. This may be due to the increased likelihood of rupture of membranes prior to the engagement of your baby in your pelvis. In women who have already had a baby, engagement occurs after labor has begun or at least later than for first time moms. Again we would contend that healthy active moms are less at risk. Walking is fantastic exercise and has been proven to reduce malpresentations.

5) Polyhydramnios

Polyhydramnios – too much amniotic fluid – is often associated with an unstable lie or an unengaged presenting part, as well as a copious flow of amniotic fluid after the membranes rupture. However, polyhydramnios is seen in few pregnancies – 0.5 to 5%. Of these, about 20% of cases are due to maternal diabetes, which causes fetal hyperglycemia (high blood sugar in your baby) and results in polyuria (excessive urine output).

Note: A majority of your baby’s amniotic fluid is composed of urine.

About another 20% of cases are associated with fetal anomalies that impair the ability of the baby to swallow.

Note: Your baby normally swallows the amniotic fluid.

However, do not be overly concerned for in 60-65% of cases of polyhydramnios, the cause is unknown.

6) Low birth weight

A baby weighing 2.5 kilos at term or about 5.5 pounds.

7) Fetal congenital abnormality

 

8) Cephalopelvic disproportion

The baby cannot fit through the mother’s pelvis. This is quite rare for your baby’s head will mold and your pelvis can open up to 33% more depending on your birthing position! More about CPD

9) Pelvic tumors

 

10) Low lying placenta or other abnormal placentation

 

11) High fetal station

The baby is still high in the pelvis rather than “engaged.”

12) Long umbilical cord

 

13) Macrosomia

Macrosomia is – arbitrarily – defined as a birth weight of more than 4000 g or 8 lbs 13 oz. Many women – including Alisha and Florence – give birth to larger babies without any problem. True macrosomia though is often associated with diabetes.

Obstetrical Interventions

Obstetrical intervention may result in an iatrogenic cord prolapse – iatrogenic means “doctor caused” – and therefore is totally preventable. The main reason for a cord prolapse is the improper engagement of your baby’s head and a gush of the amniotic fluid which then carries his cord with it. Artificial rupture of membranes (AROM) – which is very common in hospitals – is the number one culprit for cord prolapse. Another reason is induction for no medical reasons – which most of them are – and obviously before your baby is ready and properly engaged. Those two reasons – AROM and induction – are very, very unlikely in a homebirth. A cord prolapse is a complication which could be fatal in home or hospital. The National Birthday Trust Fund study of planned home births done in the United Kingdom, reported on the incidence of cord prolapse. In a study involving over 10,000 women, only one cord prolapse occurred at home but no death was reported.

 

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  • Wendy Eubanks

    My preterm baby born 7 weeks early.

    She was delivered by emergency c-section and it was very scary. Luckily I was already at the hospital due to my water breaking and I had been having preterm labor for weeks and was on medications to stop the contractions.

    The nurses did a pelvic exam and within 15 minutes i felt i needed to go to the bathroom very bad and the nurse pulled back the sheets to help me up and the cord was out prolapsed! this was a true emergency since there was no oxygen getting to my baby. The nurses rushed me to surgery and they delivered my baby within 9 minutes they said.

    i remimber before i was put under some of the nurses not even wearing scrubs yet in the surgery room. I am very thankful for their expert care during the surgery. My baby has several brain scans, heart scans and was only on oxygen for one day.

    She was able to breathe on her own awhile after surgery which was a good sign. She was in the hosptial for 18 days and we went home.

    Stevie Lynn is now 12 weeks old and now 9 lbs and doing great meeting all her milestones so far.

    They did not think at this time there was any damage to her brain due to oxygen loss. She is a true blessing and we are so thankful that she made it ok!!!!!!

    sincerely,,
    Wendy Eubanks

    • http://www.natural-motherhood.com/ Natural-Motherhood

      Wendy,

      Thank you for telling your story! I am so thankful everything turned out so well.

      Your case is a wonderful example of the proper use of medical technology for which we are all thankful.

      I am glad Stevie is doing well as you are.

      Many blessings to you and your family,

  • Segaran

    Usually one tries to have the baby out as soon as possible. ARM is done to assess meconium staining of the amniotic fluid. Again it depends on who does the ARM and how fast the amniotic fluid is drained. It is interesting to note the near absence of cord prolapse in home deliveries. Should ARM be done routinely?

  • Starlone Family

    I was induced during 40wks with my fourth child. Emergency C-section to save my precious son from prolapsed cord. Truly a miracle. Extremely terrifying and traumatic experience. We are so blessed to have our son and we thank God he is healthy.

    • Dana Thibodeaux

      I remember that day like it was yesterday. All day long we were waiting for that phone call announcing the birth of their 4th child & healthy baby boy. But unfortunately, the call we received was much different than that. I could tell right away by the tone in my cousin’s voice that something wasn’t right. Every minute, hour & day that passed was very emotional and all our family & friends were praying for Preston to get healthy soon so he could be with his family. Thank God our prayers were heard! Preston is a healthy, happy baby boy who is progressing faster than we ever could have expected! Thank God for answered prayers!

  • Anonymous

    My cord prolapse story

    I was high risk for a c-section with my son 12 years ago, due to his lack of growing in me the last 2 weeks of pregnancy. I went to a big hospital the day before for a possible c-section, but they said the baby was 5 pounds, and it was not necessary for a c-section to be performed.

    The next day, my water started to leak. I went to the local hospital where I was admittied and started on pitocin.

    My water broke a few hours later. In the afternoon, my MD checked me and realized the cord was prolapsed. He had to hold in the cord. Everything went so fast and all I could hear was “stat” and remembered being rushed into the surgical suite. While the MD was holding the pressure off the cord inside of me, I had to move myself onto the surgery table by scootching. Because it was a weekend, this local hospital did not have an anesthegiologist there. One was called from a nearby city, but because death to my son was immiment, an emergancy C-section had to be performed….With only a local to numb my skin. It was the most extreme pain I have ever felt in my life. I could literally feel their rubber gloves squeeking inside of me.

    The anastesiologist did finally show up, after my son was out. Funny thing is, is that even with my guts exposed and nothing for pain, when I saw that little blue butt, I laughed and cried. Than I was put to sleep. Thank God for their quick action or my son would not be alive. It was also a great learning experience, because they no longer deliever babies there without an anestheisiologist close by.

    • Rachel Starlone

      Your experience reminded me so much of my own.God Bless you and your family! The traumatic events that took place are so difficult for me to discuss. Absolutely terrifying to know that your baby is dying. In my case the nurse held the cord and had my husband assist her to grab a phone to call out Drs to get to the hospital to deliver my baby. Didn’t know what to expect by the time they got there. I know my experienced nurse saved my babies life. I went through the same pain of the emergency c section. I had only local. Dr told my husband your wife experienced wild horses dragging her. I was cut vertical with 24 staples. They had a breathing tube for my baby which he eventually pulled out his mouth and breathed on his own. He had erbs palsey on right arm from being pulled out. He fully recovered from that. He was being rushed to another hospital with NICU. I was not able to hold my baby. They brought him in for ne to see him and touch before they rushed him away. I was released from my hospital the next day to go see my son at the NICU. We stayed five days. My son weighed 7 lbs 15 oz at birth. He is a healthy four month old. We are forever blessed!!

  • Maria

    I was seventeen years old when i was induced into labour at 41 weeks without any abnormalities. I was induced at noon on 4/10/05, contractions started coming up, nobody checked me up until 16 hours later when i felt something going down my legs, i thought the water broke but blood was flowing out instead. Knowing that something was terribly wrong, i screamed to the midwife on duty in despair, to make things worse she called every doctor available at the moment and they looked scared more than i did. I kept asking what is happening but i was left without an answer, after like 10 minutes they told me that im going under an emergency c-section. When i woke from anaesthetic 4 hrs later they told me that my son is at intensive care due to swallowing blood. Docs told me that i was very lucky to have my baby, luckily no permanent damage was done.

    • http://www.natural-motherhood.com/ Natural-Motherhood

      Maria,

      Thank you for sharing your story. It is so sad but I am glad all turned out well.

      Blessings

  • Debbie

    I was 2 weeks over due and had to have my labour induced. 15 hours later I was taken to labour ward and to everyone’s surprise I was 8cm dilated. The midwife broke my waters at this point. I felt a small trickle but as a dr was giving me an epidural my waters gushed everywhere, they seemed to be coming away forever. it was then that the midwife realised my baby had passed moconium and she needed to put a cop on his head to monitor his heartbeat, this is what I think saved his life. The midwife couldn’t get the clip on due to my waters still coming away so she had to keep trying to get the clip on. She looked confused and left to get a dr. He came in, examined me and with one sickening look to the midwife the room filled up with medical staff and he said “c section now, no time for consent forms!” I didn’t have time to think but I can remember the silence of the machine that my sons heart beat had been booming away on only minutes earlier. My mind was overloaded with horrific thoughts that my unborn baby had died, his heart rate dropped so low, I couldn’t hear a thing just dr’s rushing round me. Less than 10 minutes later my son was son was born, he didn’t cry which only made my thoughts worse but 5 minutes on they handed him to me, a healthy 9lb boy (Kyle)
    I forgt about everything, was so overjoyed that I had my healthy baby I couldn’t have asked for more. It wasn’t until the dr came to see me the next day to explan that things went horribly wrong that I realised how different things could have bee. I llive in rural Northumberland uk over 1hr away from a main hospital. I could have had my son at a local maternity unit where the midwives had tried to persuade me to go throughout my pregnancy. Had I done so Kye would definitely not have made it. I suggest to anyone thinking abut a home birth to just consider what could go wrong, Cord prolapse is very rare, I’d never heard of it but it happened t mem had it not been picked up on when it did my baby would have died. One minute everything was perfect, just as I had wished my labour would go, the next minute it changed (very fast with no time to spare!)

    • http://www.natural-motherhood.com/ Natural-Motherhood

      Thank you so much for sharing your story. In case of induction like this you do need to be in a hospital. Inductions are one of the major reasons cord prolapse will occur.

      I am glad Kyle is here and all is well.

      Blessings

  • anzalina shermin

    death of my first baby by cord prolapse.

    i was 36 week pregnent.suddenly i felt(08-10-2012)my baby is not moving than i went to the doctor(DHAKA,BANGLADESH)dr. dit not get the heart beat of my baby.i was just feelingless and out of my head.i was 7th october 2012 at 7p.m.after that dr.told us if we want we can wait for vaginal delivery but we was very emotional becouse of my 36week death .we took decision to Caesarean and finally my baby came out but she was no more.dr.told us her death occur due to corl prolapse even when dr. gave us my baby the cord was all through her neek.i was supprised becouse before the 12 day of my caesar i went to dr. for regulat ceek up .that time i have done the altrasonograph but dr. did not realised anything.even when dr. did not find the heart beat they took altrasonugraphy that time they did not find why the baby was death.it is possible.

    • http://www.natural-motherhood.com/ Natural-Motherhood

      I am so sorry for the death of your baby.

      Blessings