UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Umbilical cord prolapse

Authors
Melissa Bush, MD
Keith Eddleman, MD
Victoria Belogolovkin, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

In overt umbilical cord prolapse, the cord slips ahead of the presenting part of the fetus and protrudes into the cervical canal or vagina, or beyond. It is an obstetrical emergency because the prolapsed cord is vulnerable to compression, umbilical vein occlusion, and umbilical artery vasospasm, which can compromise fetal oxygenation. In occult umbilical cord prolapse, the cord slips alongside, but not ahead of, the presenting part. The occult prolapsed cord is also vulnerable to compression and its sequelae. Membranes are usually ruptured in both settings.

FREQUENCY

Umbilical cord prolapse occurred in 0.17 and 0.18 percent of live born deliveries in two large series [1,2].

PATHOGENESIS

The pathogenesis of umbilical cord prolapse is not always clear. One probable mechanism is high outward flow of amniotic fluid at rupture of membranes that carries the umbilical cord past an unengaged fetal presenting part. Another probable mechanism is disengagement of the presenting part during obstetric procedures, allowing the cord to prolapse.

RISK FACTORS

Umbilical cord prolapse primarily occurs in two settings: (1) when the presenting part does not adequately fill the pelvis because of maternal or fetal characteristics, and (2) when obstetric interventions are performed that dislodge the presenting part. Although observational studies suggest that obstetric interventions increase the risk of cord prolapse, it is often difficult to determine whether cord prolapse would have occurred spontaneously if the intervention had not been performed [3].

Fetal and maternal factors that have been associated with cord prolapse include:

                     

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Fri Jan 29 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Gannard-Pechin E, Ramanah R, Cossa S, et al. [Umbilical cord prolapse: a case study over 23 years]. J Gynecol Obstet Biol Reprod (Paris) 2012; 41:574.
  2. Gibbons C, O'Herlihy C, Murphy JF. Umbilical cord prolapse--changing patterns and improved outcomes: a retrospective cohort study. BJOG 2014; 121:1705.
  3. Roberts WE, Martin RW, Roach HH, et al. Are obstetric interventions such as cervical ripening, induction of labor, amnioinfusion, or amniotomy associated with umbilical cord prolapse? Am J Obstet Gynecol 1997; 176:1181.
  4. Usta IM, Mercer BM, Sibai BM. Current obstetrical practice and umbilical cord prolapse. Am J Perinatol 1999; 16:479.
  5. Gabbay-Benziv R, Maman M, Wiznitzer A, et al. Umbilical cord prolapse during delivery - risk factors and pregnancy outcome: a single center experience. J Matern Fetal Neonatal Med 2014; 27:14.
  6. Hasegawa J, Sekizawa A, Ikeda T, et al. The use of balloons for uterine cervical ripening is associated with an increased risk of umbilical cord prolapse: population based questionnaire survey in Japan. BMC Pregnancy Childbirth 2015; 15:4.
  7. Boyle JJ, Katz VL. Umbilical cord prolapse in current obstetric practice. J Reprod Med 2005; 50:303.
  8. Koonings PP, Paul RH, Campbell K. Umbilical cord prolapse. A contemporary look. J Reprod Med 1990; 35:690.
  9. Barclay M. Umbilical cord prolapse and other cord accidents. In: Gynecology and Obstetrics, Sciarra JJ (Ed), JB Lippincott, Philadelphia 1989. p.1.
  10. Ylä-Outinen A, Heinonen PK, Tuimala R. Predisposing and risk factors of umbilical cord prolapse. Acta Obstet Gynecol Scand 1985; 64:567.
  11. Uygur D, Kiş S, Tuncer R, et al. Risk factors and infant outcomes associated with umbilical cord prolapse. Int J Gynaecol Obstet 2002; 78:127.
  12. Murphy DJ, MacKenzie IZ. The mortality and morbidity associated with umbilical cord prolapse. Br J Obstet Gynaecol 1995; 102:826.
  13. Critchlow CW, Leet TL, Benedetti TJ, Daling JR. Risk factors and infant outcomes associated with umbilical cord prolapse: a population-based case-control study among births in Washington State. Am J Obstet Gynecol 1994; 170:613.
  14. Qureshi NS, Taylor DJ, Tomlinson AJ. Umbilical cord prolapse. Int J Gynaecol Obstet 2004; 86:29.
  15. Altaras M, Potashnik G, Ben-Adereth N, Leventhal H. The use of vacuum extraction in cases of cord prolapse during labor. Am J Obstet Gynecol 1974; 118:824.
  16. Kahana B, Sheiner E, Levy A, et al. Umbilical cord prolapse and perinatal outcomes. Int J Gynaecol Obstet 2004; 84:127.
  17. Smyth RM, Markham C, Dowswell T. Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev 2013; :CD006167.
  18. Siassakos D, Hasafa Z, Sibanda T, et al. Retrospective cohort study of diagnosis-delivery interval with umbilical cord prolapse: the effect of team training. BJOG 2009; 116:1089.
  19. Duval C, Lemoine JP, Ba S, Demory JE. [Prolapse of the umbilical cord. 79 cases]. Rev Fr Gynecol Obstet 1987; 82:163.
  20. Vago T. Prolopse of the umbilical cord: a method of management. Am J Obstet Gynecol 1970; 107:967.
  21. Lin MG. Umbilical cord prolapse. Obstet Gynecol Surv 2006; 61:269.
  22. Katz Z, Shoham Z, Lancet M, et al. Management of labor with umbilical cord prolapse: a 5-year study. Obstet Gynecol 1988; 72:278.
  23. Barrett JM. Funic reduction for the management of umbilical cord prolapse. Am J Obstet Gynecol 1991; 165:654.
  24. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-50-umbilicalcordprolapse-2014.pdf (Accessed on November 09, 2015).
  25. Smit M, Zwanenburg F, van der Wolk S, et al. Umbilical cord prolapse in primary midwifery care in the Netherlands; a case series. Part 2. Pract Midwife 2014; 17:34.
  26. 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; 17:24.
  27. Poetker DM, Rijhsinghani A. Fetal survival after umbilical cord prolapse for more than three days. A case report. J Reprod Med 2001; 46:776.
  28. Gilbert WM, Jacoby BN, Xing G, et al. Adverse obstetric events are associated with significant risk of cerebral palsy. Am J Obstet Gynecol 2010; 203:328.e1.
  29. Lange IR, Manning FA, Morrison I, et al. Cord prolapse: is antenatal diagnosis possible? Am J Obstet Gynecol 1985; 151:1083.
  30. Ezra Y, Strasberg SR, Farine D. Does cord presentation on ultrasound predict cord prolapse? Gynecol Obstet Invest 2003; 56:6.
  31. Raga F, Osborne N, Ballester MJ, Bonilla-Musoles F. Color flow Doppler: a useful instrument in the diagnosis of funic presentation. J Natl Med Assoc 1996; 88:94.
  32. Kinugasa M, Sato T, Tamura M, et al. Antepartum detection of cord presentation by transvaginal ultrasonography for term breech presentation: potential prediction and prevention of cord prolapse. J Obstet Gynaecol Res 2007; 33:612.