Umbilical cord prolapse

is considered when it appears in the vagina, ahead of presentation, and the bag of waters is broken. It arises with a frequency of 1 in 300 deliveries.

Related to this pathology, there are two similar terms:

• Procubitus: when the umbilical cord is located in front of the presentation, but the bag of waters remains intact.
• Procidence or laterocidence: when the umbilical cord is arranged next to the presentation without exceeding it.

Why is it produced?

All the factors that prevent a good adaptation of the presentation to the superior strait of the maternal pelvis will favor the appearance of cord prolapse.

Among them, the following should be highlighted:

• Multiparity: due to the fact that they have a higher frequency of anomalies in the situation and presentation of the fetus, prolapse being more frequent in oblique and transverse situations.
• Narrow pelvis: which prevents a good accommodation of the presentation.
• Polyhydramnios : in which the rupture of the bag of waters produces a sudden outflow of amniotic fluid, which can drag the umbilical cord with it.
• Prematurity, twin pregnancies, and low-insertion placentas.
• Amniorrhexis: If the doctor does not perform it properly, it can cause a prolapsed cord.

The prolapse of the umbilical cord originates when the bag of waters breaks, either naturally or artificially, by means of amniorrhexis, and the presentation (usually usually the head of the fetus) does not fit on the mother’s pelvis, leaving a space through which the umbilical cord can descend, until it is below the fetal head. In this situation, the umbilical cord can become compressed between the child’s head and the mother’s pelvis, leading to a number of problems for the child.

Symptoms of umbilical cord prolapse

The symptoms produced by a prolapse of the umbilical cord affect the fetus, appearing alterations in the fetal heartbeat after the rupture of the bag of waters, which translates into insufficient oxygenation of the fetus, due to the compression of the cord.

How is it diagnosed?

In cases of procubitus, they can also be diagnosed by vaginal examination, in which the umbilical cord is palpated behind the bag of waters. However, it is very difficult to diagnose the existence of a laterocidence of the cord by performing a vaginal examination.

Another very useful test is ultrasound, in which both procubitus and laterocidences can be observed.

Umbilical cord prolapse treatment

Treatment of prolapsed cord requires immediate termination of labor and depends, fundamentally, on three factors:

• The degree of cervical dilation.
• The type of presentation.
• The state of the fetus.

If the dilation is not complete, a cesarean section is indicated.

In cases of transverse situations, in multiparous patients without objective pathology and in complete dilatation, if the bag has just ruptured, maneuvers, such as the internal version, followed by large extraction, can be attempted, although, due to the high frequency of complications that appear With these techniques, a cesarean section is often preferred.

If the presentation is cephalic and it is already deeply embedded in the pelvis, with full dilation, an attempt can be made to apply a forceps, which will allow the case to be solved quickly.

In the event that the fetus is dead, labor must be allowed to evolve vaginally, if there is no other cause that prevents it.

How can I avoid it?

To avoid the development of a prolapse of the umbilical cord, the most important thing is that the woman go to the hospital as soon as the labor begins.

Keep in mind that the longer it takes from the time the prolapse occurred until it is treated correctly, the worse the prognosis for the fetus.

Any pregnant woman who begins to have uterine contractions, which indicate that labor is beginning, should see her gynecologist so that she can be treated properly and in the best possible conditions.