Umbilical cord prolapse

You rupture the membranes on a woman at 4 cm with a head that is not quite engaged. A litre of clear liquor comes away, and eight seconds later the heart rate falls to 70 and stays there. Your hand is already reaching for the glove.^[10][11]

This emergency is won in the first thirty seconds and lost by anyone who takes their hand out. Everything else — the trolley, the anaesthetist, the consent — happens around a clinician who is not moving.^[2][4]

Overview and definition

• Overt prolapse: the cord descends past the presenting part through ruptured membranes, and you can see or feel it in the vagina or at the introitus.^[1][19]
• Occult prolapse: the cord lies alongside the presenting part, compressed between it and the pelvic wall. You cannot palpate it — the trace tells you and nothing else does.^[1][19]
• Cord (funic) presentation: the cord lies below the presenting part with the membranes intact. Different problem, different answer: do not rupture, plan a caesarean.^[1][9]

A contemporary paper argues the anatomical definition is too narrow, because compression physiology — not the position of the membranes — is what harms the fetus, and cases occur with membranes apparently intact. Know the classical definition, then be able to say why it is contested.^[2]

References20ShowHide

1. [1]Pagan M, Eads L, Sward L, et al. Umbilical Cord Prolapse: A Review of the Literature Obstet Gynecol Surv, 2020.PMID 32856717
2. [2]Wong L, Kwan AHW, Lau SL, et al. Umbilical cord prolapse: revisiting its definition and management Am J Obstet Gynecol, 2021.PMID 34181893
3. [3]Wong L, Tse WT, Lai CY, et al. Bradycardia-to-delivery interval and fetal outcomes in umbilical cord prolapse Acta Obstet Gynecol Scand, 2021.PMID 32862427
4. [4]Kwan AHW, Chaemsaithong P, Wong L, et al. Transperineal ultrasound assessment of fetal head elevation by maneuvers used for managing umbilical cord prolapse Ultrasound Obstet Gynecol, 2021.PMID 33219729
5. [5]Bord I, Gemer O, Anteby EY, et al. The value of bladder filling in addition to manual elevation of presenting fetal part in cases of cord prolapse Arch Gynecol Obstet, 2011.PMID 20473615
6. [6]Murphy DJ, MacKenzie IZ The mortality and morbidity associated with umbilical cord prolapse Br J Obstet Gynaecol, 1995.PMID 7547741
7. [7]Hehir MP, Hartigan L, Mahony R, et al. Perinatal death associated with umbilical cord prolapse J Perinat Med, 2017.PMID 27831923
8. [8]Behbehani S, Patenaude V, Abenhaim HA, et al. Maternal Risk Factors and Outcomes of Umbilical Cord Prolapse: A Population-Based Study J Obstet Gynaecol Can, 2016.PMID 26872752
9. [9]Hasegawa J, Ikeda T, Sekizawa A, et al. Obstetric risk factors for umbilical cord prolapse: a nationwide population-based study in Japan Arch Gynecol Obstet, 2016.PMID 26714678
10. [10]Tallhage S, Årestedt K, Schildmeijer K, et al. Incidence and risk factors for umbilical cord prolapse in labor when amniotomy is used and with spontaneous rupture of membranes: A Swedish nationwide register study Acta Obstet Gynecol Scand, 2024.PMID 37969005
11. [11]Kawakita T, Huang CC, Landy HJ, et al. Risk Factors for Umbilical Cord Prolapse at the Time of Artificial Rupture of Membranes AJP Rep, 2018.PMID 29755833
12. [12]Houri O, Walfisch A, Shilony A, et al. Decision-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse BMC Pregnancy Childbirth, 2023.PMID 37349738
13. [13]Copson S, Calvert K, Raman P, et al. The effect of a multidisciplinary obstetric emergency team training program, the In Time course, on diagnosis to delivery interval following umbilical cord prolapse - A retrospective cohort study Aust N Z J Obstet Gynaecol, 2017.PMID 27604839
14. [14]Gallagher G, Griffin A, Clipperton S, et al. Impact of simulation training on decision to delivery interval in cord prolapse BMJ Simul Technol Enhanc Learn, 2021.PMID 35520957
15. [15]Smit M, Zwanenburg F, van der Wolk S, et al. Umbilical cord prolapse in primary midwifery care in the Netherlands; a case series Pract Midwife, 2014.PMID 25004700
16. [16]Asahina R, Tsuda H, Nishiko Y, et al. Evaluation of the risk of umbilical cord prolapse in the second twin during vaginal delivery: a retrospective cohort study BMJ Open, 2021.PMID 34135046
17. [17]Nakanishi K, Yamamoto R, Imanishi Y, et al. Umbilical cord prolapse after preterm premature rupture of membranes Taiwan J Obstet Gynecol, 2022.PMID 35595443
18. [18]Sayed Ahmed WA, Hamdy MA Optimal management of umbilical cord prolapse Int J Womens Health, 2018.PMID 30174462
19. [19]Holbrook BD, Phelan ST Umbilical cord prolapse Obstet Gynecol Clin North Am, 2013.PMID 23466132
20. [20]Vago T The management of prolapse of the umbilical cord Am J Obstet Gynecol, 1994.PMID 8178890