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Umbilical cord prolapse: Treatment, symptoms, advice and help

About umbilical cord prolapse

It is defined as descent of the umbilical cord along with the advancing presenting part of the foetus in the birth canal. It invariably occurs during labour or if the membranes rupture and the amniotic fluid escapes even before labour sets in.

It may be overt if the cord has advanced well below the presenting part or occult when the cord is by the side of the presenting part. The covering fore membranes are absent in this condition. The same situation with the fore membranes covering is called as cord presentation. It is a life threatening condition for the foetus.

Umbilical cord prolapse: Incidence, age and sex

The incidence ranges from 0.14 to 0.62 percent. It is higher in cases of breech presentation.

Signs and Symptoms of umbilical cord prolapse: Diagnosis

The condition can be suspected when there is abnormal fetal heart rate patterns or when the women has a sudden gush of amniotic fluid coming out of vagina. The condition is confirmed on vaginal examination when the cord can be actually felt along side or in front of the fetal presenting part. High index of suspicion is necessary in women with risk factors. Vaginal examination must be performed whenever a woman ruptures membrane to pick up this condition early.

Causes and prevention of umbilical cord prolapse

The condition is likely to occur when the presenting part is not snugly fitting in the birth canal. Big babies, malposition and foetuses presenting with part other than head are at higher risk. The risk is also higher when the cord is too long or when the placenta is low lying or there is excess of amniotic fluid as also in multiple pregnancies. Interventions like artificial rupture of membranes and induction of labor when the head is high also increase the risk. It is more likely to occur in multiparous women due to increase in predisposing risk factors with advancing parity and age. Very young primigravidae who have disproportionately smaller pelvis are also at higher risk.

It can be prevented by anticipating this condition by risk assessment and delivering these women safely in hospitals in skilled hands. It can be averted by performing caesarean section in certain conditions like malpresentations.

Umbilical cord prolapse: Complications

This condition endangers the life of the foetus if not delivered promptly. In some unfortunate situations like contracted pelvis and neglected shoulder presentations, a cesarean may be necessary even if the baby is dead. If left unattended, the fetus dies and infections can ascend up.

Umbilical cord prolapse: Treatment

Prompt recognition is important to save the baby. The women must be promptly delivered once this condition occurs. If vaginal delivery is not imminent an emergency caesarean section should be performed. The presenting part must be prevented from compressing the cord till the baby is delivered by caesarean. This can be achieved with the sterile gloved hand of the obstetrician inside the vagina of the woman to lift the presenting part. Filling the urinary bladder, trendlenberg position and sometimes relaxing the uterus with drugs also help.