Umbilical cord prolapse
- Occurs in 0.5% of pregnancies
- Likely secondary to the presenting fetal part not filling enough of the lower uterus and allowing cord to present first during labor.
- Risk factors
- Low birth weight
- Fetal malpresentation
- Presentation of umbilical cord before fetal delivery (can be felt as pulsatile structure on exam)
- Emergent delivery
- Umbilical cord prolapse
- Breech delivery
- Shoulder dystocia
- Perimortem cesarean delivery
- Clinical diagnosis
- Emergent OB/Gyn consult
- Do NOT attempt to reduce cord
- Elevate presenting fetal part to reduce compression and transport to OR for emergent C-section
- Examiner who diagnosed umbilical cord prolapse must maintain umbilical decompression until patient is in OR
- Place patient in knee-chest position and encourage not to push or cough
- May also consider Trendelenburg position (if patient can tolerate) to let gravity assist in moving fetus off pelvic floor
- Admit to L&D
- Mercado J, Brea I, Mendez B, et al. Critical obstetric and gynecologic procedures in the emergency department. Emerg Med Clin North Am. 2013 Feb;31(1):207-36.
- Holbrook BD. Umbilical cord prolapse. Obstet Gynecol Clin North Am. 2013 Mar;40(1):1-14.