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Umbilical cord prolapse

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


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.


Umbilical cord prolapse occurred in 0.16 to 0.18 percent of live born deliveries in three large series [1-3], the rate may be slowly declining [3].


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.


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 [4].

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

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Literature review current through: Nov 2017. | This topic last updated: Oct 11, 2017.
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