Umbilical cord prolapse

Background

  • 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.[1]
  • Risk factors[1]
    • Low birth weight
    • Multiparity
    • Fetal malpresentation

Clinical Features

  • Presentation of umbilical cord before fetal delivery (can be felt as pulsatile structure on exam)

Differential Diagnosis

Emergent delivery and related complications

Evaluation

  • Clinical diagnosis

Management

  • Emergent OB/Gyn consult
  • Do NOT attempt to reduce cord - instead, elevate the presenting fetal part to reduce compression and transport to OR for emergent C-section[2]
    • 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[1]

Disposition

  • Admit to L&D

See Also

External Links

References

  1. 1.0 1.1 1.2 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.
  2. Holbrook BD. Umbilical cord prolapse. Obstet Gynecol Clin North Am. 2013 Mar;40(1):1-14.