Placenta
Gross / macroscopic variations and conditions
Umbilical cord
Prolapsed umbilical cord
Author: Paul J. Kowalski, M.D.
Last author update: 1 May 2016
Last staff update: 28 October 2020
Copyright: 2002-2023, PathologyOutlines.com, Inc.
PubMed Search: Prolapsed umbilical cord
Table of Contents
Definition / general | Epidemiology | Pathophysiology | Etiology | Diagrams / tables | Clinical features | Diagnosis | Case reports | Treatment | Gross description | Microscopic (histologic) descriptionCite this page: Kowalski PJ. Prolapsed umbilical cord. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/placentaprolapsed.html. Accessed May 30th, 2023.
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
- 28 year old gravida 1, para 0 woman at 23 weeks with umbilical cord prolapse (J Reprod Med 2001;46:776)
- 29 year old woman with twin gestation, premature rupture of membranes and umbilical cord prolapse (Fetal Diagn Ther 1998;13:147)
- Cord prolapse due to an excessively long umbilical cord (Eur J Obstet Gynecol Reprod Biol 1999;84:101)
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)
