What Is an Umbilical Cord Prolapse?

When the umbilical cord prolapses from below the fetal exposure, it enters the vagina through the cervix, and is even exposed to the vulva through the vagina. Umbilical cord prolapse can cause umbilical cord compression, fetal blood supply disturbance, fetal distress or even endanger fetal life. The umbilical cord is located in front of or on the side of the exposed fetus, and the fetal membrane is not broken.

Basic Information

nickname: True umbilical cord prolapse
English name: prolapse of cord
Visiting department: Obstetrics and Gynecology

Common causes: Abnormal fetal exposure, floating fetal head, premature birth or twin pregnancy
Common symptoms: Acute fetal hypoxia, changes in fetal heart rate

Causes of umbilical cord prolapse

Umbilical cord prolapse can occur where the exposed part of the fetus is not closely connected with the plane of the pelvic entrance and there is a gap between the two. The main reasons are:

Abnormal fetal exposure

It is the main cause of umbilical prolapse, which is more common in the horizontal position (shoulder first exposure) and foot first exposure. Most of the hip first exposure occurs in the foot first exposure, while the single hip first exposure can often be closely connected with the pelvic cavity, and fewer umbilical prolapses occur. Posterior occipital, facial, and other abnormal heads first exposed or compound first exposed, often do not completely fill the pelvic entrance, fetal head only after the rupture of the membrane, easy to induce umbilical cord prolapse.

2.Fetal head floating

The pelvis is narrow or the fetus is overdeveloped, the fetal head does not fit the pelvic entrance (the pelvis is not called), or the maternal abdominal wall is often loose after the beginning of labor. .

3. Premature or twin pregnancy

Twin pregnancy tends to occur before the second fetus is delivered, which may be related to the fetus being too small, the fetal first exposure cannot be closely connected with the pelvic entrance, or the high incidence of abnormal fetal positions.

4. Placenta is low (or has umbilical cord edge attachment)

A low placenta can lead to an inability to engage the fetal exposure or abnormal fetal position, especially when the umbilical cord is attached to the lower edge of the placenta, increasing the risk of umbilical cord prolapse.

5. The umbilical cord is too long

For example, when the exposed part is commensurate with the pelvis, the length of the umbilical cord is not the main reason for prolapse of the umbilical cord, but when the fetal head cannot be connected, the prolonged umbilical cord is prone to prolapse. Those with a umbilical cord length of more than 75cm are 10 times more likely to have prolapse than those with a normal umbilical cord length (50-55cm).

6. Other

Such as early membrane rupture, too much amniotic fluid, the latter when the fetal membrane ruptures, because the intrauterine pressure is too high, the amniotic fluid flows too quickly, and the umbilical cord can be washed out by the amniotic fluid to form umbilical cord prolapse.

Clinical manifestations of umbilical cord prolapse

Umbilical cord prolapse has little effect on the mother, it only increases the surgical yield, but it is very harmful to the fetus. When the umbilical cord prolapses, the umbilical cord is compressed between the exposed part of the fetus and the pelvis, causing acute hypoxia in the fetus, changing the fetal heart rate, or even completely disappearing. If the umbilical cord blood is blocked for more than 7 minutes, it can lead to intrauterine death.

Umbilical cord prolapse diagnosis

When there are high-risk factors for umbilical cord prolapse, the condition of the fetus should be monitored to guard against the occurrence of umbilical cord prolapse. When abnormal fetal heart rate occurs after the rupture of the membrane, a vaginal examination should be performed immediately. If a pulsating cord (umbilical cord) is touched in front of the fetal exposure, a umbilical cord prolapse can be diagnosed.

Umbilical cord prolapse examination

According to the condition and vaginal examination, the umbilical cord prolapse can be clearly diagnosed. Invisible prolapse of the umbilical cord can be detected by ultrasound Doppler examination.

Umbilical cord prolapse treatment

Early detection and correct handling are the key to the survival of the perinatal child.

1. When the fetal membrane is not broken and a hidden umbilical cord prolapse is found

The mother should rest in bed, take her hips high and her head down, and observe the fetal heart rate closely. Due to the action of gravity, Lu first withdraws from the pelvic cavity, reducing the pressure on the umbilical cord, and changing the position, the possibility of the umbilical cord to return. If the head is exposed first, the uterine contraction is good, the fetal heart rate is normal when exposed first, and the uterine mouth is dilated progressively, which can be delivered through the vagina. Otherwise, cesarean section is safer.

2. When umbilical cord prolapse is found after membrane rupture

Race against time to rescue. In order to avoid or reduce umbilical cord compression, the parturient adopts high hips and low heads to restrain contractions, and the midwife pushes the exposed part of the fetus through the vagina by hand to reduce the umbilical cord compression. According to the degree of dilation of the uterine cavity and the situation of the fetus, the corresponding treatment is performed.

(1) The uterine opening is complete and the fetal heart is present. The fetus should be delivered within a few minutes. Those with a cephalopelvic balance should immediately perform forceps or suction to assist in giving birth; breech traction in the buttocks; introversion of the shoulders and introversion and breech traction to assist delivery If the child cannot be delivered quickly and the fetal heart is abnormal, in order to rescue the newborn, a cesarean section should be performed immediately.

(2) The uterine opening has not been enlarged, and it is estimated that those who cannot deliver the fetus in a short period of time should perform cesarean section quickly. When preparing for surgery, raise the maternal hips to prevent further umbilical cord prolapse. The hand of the vaginal examiner can push the fetal exposed part in the vagina, and separate the fingers between the exposed part and the pelvic wall, so that the umbilical cord passes through the finger seams to avoid compression. Monitor the fetal condition according to the umbilical cord pulse Rescue until the fetus is delivered.

(3) If the fetal heart has disappeared, it can be delivered naturally through the vagina.

(4) On the basis of the above treatments, preparations for rescuing newborns with asphyxia should be made.