Placenta
Umbilical cord
Prolapsed umbilical cord

Author: Paul J. Kowalski, M.D. (see Authors page)

Revised: 18 October 2017, last major update May 2016

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Prolapsed umbilical cord
Cite this page: Kowalski, P.J. Prolapsed umbilical cord. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/placentaprolapsed.html. Accessed October 22nd, 2017.
Definition / general
  • Cord prolapse occurs when the umbilical cord is expelled with or prior to the fetus during the fetal presentation process
Epidemiology
  • Approximately 0.4 - 0.5% of deliveries are complicated by cord prolapse
Pathophysiology
  • Lack of fetal engagement within the uterus may create a space or gap that allows the umbilical cord to slip pass the fetus and into the birth canal
  • Umbilical cord can become markedly compressed when delivered with or before the fetus
  • Umbilical cord vascular occlusion and decreased placental venous return can severely limit fetal oxygenation capacity
Etiology
  • Spontaneous or artificial rupture of membranes are a major cause
  • Other risk factors include those that perturb the appropriate filling of the pelvic space (engagement) by the fetus: an abnormal fetal lie / position, prematurity or low birth weight fetus, polyhydramnios, multiple gestation pregnancy, multiparity
  • Umbilical cord abnormalities, such as a long umbilical cord, are also a risk factor
Diagrams / tables

Images hosted on other servers:

Schematic representation of cord
prolapse preceding delivery

Clinical features
  • Umbilical cord prolapse is an obstetrical emergency and is associated with perinatal mortality in 5 - 15% of cases
Diagnosis
  • Sudden decreases in fetal heart rate
  • Moderate to severe variable decelerations on fetal heart tracing
  • A portion of umbilical cord may be detected on vaginal examination
  • Antenatal ultrasound may show cord herniation into the lower uterine segment / cervical canal
Case reports
Treatment
  • Emergent cesarean section to prevent neurologic consequences or fetal death
Gross description
  • Usually no gross abnormality is seen unless complicated by another pathologic process, such as vascular thrombosis
  • If prolonged, the affected portion of prolapsed umbilical cord may appear dusky
Microscopic (histologic) description
  • Usually no microscopic abnormality is appreciated (unless complicated by another pathologic process)