What is Umbilical Cord Prolapse?

Sometimes, before or during labor, the umbilical cord can slip through the cervix after your water breaks, preceding the baby into the birth canal. The cord may even stick out from the vagina — a dangerous situation because the blood flow through the umbilical cord can become blocked or stopped. You may feel the cord in the birth canal if it prolapses, and may see the cord if it protrudes from your vagina. This is an emergency: Call an ambulance and get to the hospital right away.

What is Umbilical Cord Compression?

Sometimes the umbilical cord gets stretched and compressed during labor, leading to a brief slow down in blood flow to your baby. This can cause sudden, short drops in fetal heart rate, called variable decelerations, which are usually picked up by monitors during labor. Umbilical cord compression can occur during pregnancy or during labor. Umbilical cord compression occurs in approximately 1 in 10 deliveries. The majority of compressions will occur during labor with most of those being mild and of less concern.
While umbilical cord compression occurs more often during labor, it can still occur during the later stages of pregnancy when your baby begins to move around more vigorously. During pregnancy and labor, many babies will experience very mild periodic compressions that are harmless.

However, there are cases in which the compression on the umbilical cord can be more extreme and last for longer periods of time. Considering that the umbilical cord allows vital nutrients and oxygen to be passed on to your baby to the placenta when there is extreme compression lasting for longer periods of time, it leads to a decrease in oxygen and blood flow to your baby.
The compression can also cause changes in your baby’s heart rate.

What are the Dangers

When your baby’s heart rate changes as a result of compression, it can lead to complications like variable deceleration. Variable deceleration involves a fall in your baby’s heart rate; the heart rate must be less than 115 bpm and last more than 15 seconds but less than 10 minutes.
Umbilical cord compression can cause changes in your baby’s blood pressure due to the changes in heart rate and lack of oxygen. During umbilical cord compression, the vein on the umbilical cord becomes compressed leading to CO2 (carbon dioxide) to accumulate in your baby’s blood, which produces respiratory acidosis.

If the umbilical cord becomes compressed during pregnancy or during labor, the risk of damage is determined by the duration of time in which the umbilical cord was compressed. When the umbilical cord is compressed for a prolonged period of time, there is a decrease in blood flow and oxygen to your baby’s brain.

This can lead to a risk of brain damage to your baby. A compressed umbilical cord can also lead to short episodes of fetal hypoxia, which involves the baby being deprived of oxygen in the womb and can lead to other health complications including death. This is rare and something your health care provider will monitor.

What Causes a Prolapsed Umbilical Cord?

During labor, the umbilical cord gets stretched and compressed, leading to umbilical cord compression.  While you are pregnant, the hyperactivity of your baby can, on rare occasions, cause umbilical cord compression.  Another cause is a preterm premature rupture of membranes (PROM).

Preterm premature rupture of membranes involves the rupture of the unborn baby’s membranes before the onset of labor.  When PROM occurs before 32 weeks of pregnancy, umbilical cord compression occurs 32 to 76 percent of the time.  Umbilical cord prolapse, which involves the umbilical cord descending into the birth canal before the baby during labor, is another possible cause of a compressed umbilical cord.

How do I Know if the Umbilical Cord is Compressed or Prolapsed?

Umbilical cord compression can be diagnosed before labor by one of two doctors test; either a fetal Doppler or an ultrasound. Unfortunately, there are no visible signs of umbilical cord compression that can be seen without the help of a doctor.

Treatments

One of the leading treatments of umbilical cord compression is amnioinfusion. Amnioinfusion is a process that involves introducing a saline solution, at room temperature, into the uterus during labor in order to relieve the pressure that can potentially lead to the umbilical cord becoming compressed.

When umbilical cord compression is minor, the method of treatment is to increase the mother’s oxygen, in order to increase the blood flow through the umbilical cord.  In more severe cases of umbilical cord compression, there should be constant monitoring of your unborn baby by your healthcare provider to assess if there are signs of distress, in which case emergency action should be taken.
If your baby shows signs of distress or if your baby’s heart rate suddenly shows signs of short drops in the heart rhythm, a C-section may be necessary to ensure your baby’s health.

Want to Know More?

Compiled from the following Resources:
Center for experiential learning. Variable Deceleration. Retrieved from
Cerebral Palsy FAQ. Why is umbilical cord compression a concern for the fetus? Retrieved from https://www.cerebral-palsy-faq.org/questions/why-is-umbilical-cord-compression-a-concern-for-the-fetus/
Collins. (2012, August 28).  Umbilical Cord Accidents.  Retrieved from https://www.biomedcentral.com/1471-2393/12/S1/A7/#B6
Cunningham, Leveno &Bloom (2005). Williams Obstetrics( 22nd ed). New York, NY: McGraw-Hill
Gardner, Giussani. (2003, June 30). Enhanced Umbilical Blood Flow During Acute Hypoxemia After Umbilical
Cord Compression: A Role for Nitric Oxide.  Retrieved from https://circ.ahajournals.org/content/108/3/331.full.pdf+html
Hofmeyr (1997, October 19). Amnioinfusion for potential or suspected umbilical cord compression in labor
(review). Retrieved from https://apps.who.int/rhl/reviews/CD000013.pdf
Pacific Medical Law. (2014). Umbilical Cord Compression.
Reece & Barbieri (2010). Obstetrics and Gynecology: The Essentials of Clinical Care. New York, NY: Thieme