Umbilical cord prolapse

Prolapse of the umbilical cord means the protrusion of one or more loops of the umbilical cord, most often after a rupture of the sac of membranes. Umbilical cord prolapse occurs when the umbilical cord presses on the part located between the cervix and the leading point of the pressing part of the fetus. After breaking the sac of membranes, it can get in front of the leading point of the fetus and this is what causes the hernia.

Division

  1. Hidden/occult prolapse - the umbilical cord has protruded towards the urgent part of the fetus, but this protrusion cannot be detected by vaginal examination
  2. Complete prolapse - the umbilical cord protrudes in front of the urgent part of the fetus, it can be felt during a vaginal examination or is even visible in the vaginal entrance


Causes of Prolapse

Maternal Causes

  • Mother's Narrowed Pelvis
  • Occurrence of pelvic tumors
  • Multiparity, etc.

Fetal causes

  • Hypotrophy and lower birth weight
  • Premature delivery
  • Congenital developmental defects
  • Cephalopelvic disproportion

Fetal placement in the uterus

  • Transverse position
  • Slanted position
  • Pelvic end position complete/incomplete

Placenta and umbilical cord causes

  • Low-grade placenta praevia]- i.e. low-grade placenta praevia
  • Abnormally long umbilical cord' - i.e. more than 75 cm
  • A small amount of Wharton's jelly

Causes from the side of the amount of amniotic fluid

  • Large amount of VP ⇒ outflow of a higher amount of water can cause the umbilical cord to come under current in front of the pressing part/s of the fetus

Causes by personnel

  • Diruption of the membrane sac
  • Turn by external senses
  • Reversal by internal palps in the other twin

Initial symptoms of umbilical cord prolapse

Occult prolapse of the umbilical cord

Occult or hidden prolapse of the umbilical cord initially manifests as transient compression, but later there is a significant bradycardia and deceleration. Cardiotocographic recording of the fetus during labor helps us to detect this prolapse.

Complete prolapse of the umbilical cord

With complete prolapse of the umbilical cord, the fetus can be affected by "severe asphyxia" caused by both "mechanical compression" of the umbilical cord by pressing parts of the fetus and "functional spasm" of the umbilical vessels.

Procedure for detecting a prolapsed umbilical cord

  1. Determine if the fetus is alive and monitor its condition at all times
  2. Release compressed umbilical cord- position change (Trendelenburg position)
  3. Terminate the pregnancy immediately by acute caesarean section


If the fetus dies, it waits for a spontaneous course, or labor is induced.

References

  • PAŘÍZEK, Antonín, and the team. Critical situations in obstetrics. 1st edition edition. Prague. 2012. 285 p.ISBN 978-80-7262-949-7