Gross / macroscopic variations and conditions

Umbilical cord

Prolapsed umbilical cord

Last author update: 1 May 2016
Last staff update: 28 October 2020

Copyright: 2002-2023,, Inc.

PubMed Search: Prolapsed umbilical cord

Paul J. Kowalski, M.D.
Page views in 2022: 333
Page views in 2023 to date: 198
Cite this page: Kowalski PJ. Prolapsed umbilical cord. website. 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
  • Approximately 0.4 - 0.5% of deliveries are complicated by cord prolapse
  • 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
  • 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:

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
  • 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
  • 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)
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