Umbilical cord prolapse is when, during labor, the umbilical cord comes out of the uterus with or before the presenting part of the baby. The concern with cord prolapse is that pressure on the cord from the baby will compromise blood flow to the baby.
The greatest risk factor is having had more than two previous children with the current baby in an abnormally positioned within the uterus. Other risks include a premature or small baby, twin pregnancy, and too much amniotic fluid. Whether medical rupture of the amniotic sac is a risk is controversial. The diagnosis should be suspected if there is a sudden decrease in the babies heart rate during labor. Seeing or feeling the cord confirms the diagnosis.
Management focuses on quick delivery, usually by cesarean section. Filling the bladder or pushing up the baby by hand is recommended until this can take place. The knee-chest position, or if this is not possible Trendelenburg position may be used. With appropriate management, the majority of cases have good outcomes.
Umbilical cord prolapse occurs in about 1 in 500 pregnancies. The risk of death of the baby is about 10%. However, much of this risk is due to congenital anomalies or prematurity. It is considered an emergency.