Prolapse of Umbilical Cord

Posted by Healthfitline On Tuesday, January 22, 2013
Umbilical cord is a tube that connects the mother and fetus. The main purpose of an umbilical cord is to transport nutrients from the mother to the fetus and to remove waste products that the fetus produces during intrauterine life.  Prolapse of the umbilical cord is a birth complication that occurs when a loop of an umbilical cord slides down before the presenting part. The umbilical cord is usually the first one to come out, before the head part of the baby. 
How is Cord Prolapse Detected
Cord prolapse can happen any time after the rupture of the membrane, usually the doctor will see or palpate the cord during a vaginal examination or it may be detected during a sonogram. If detected earlier before the rupture of membrane, a cesarean birth is usually recommended to prevent the cord from getting trapped on the fetus during delivery and to avoid serious permanent fetal brain damage.
Causes of Cord Prolapse
The following are risks factors that are associated with cord prolapse;
  • Premature rupturing of the membrane.
  • Tumors of the uterine that prevent the presenting part from engaging properly.
  • Babies who are small in size (small for gestation).
  • Pelvic diseases that affect the engagement.
  • Women carrying more than one fetus (multiple gestation).
  • Placenta implanted on the lower part of uterus rather than the upper part (placenta previa).
  • Other fetal presentations like breech rather than cephalic.
  • Longer umbilical cords
  • Excessive amount of amniotic fluid
Cord Prolapse Management
The management of cord prolapse is directed towards relieving pressure on the fetal presenting part (head). The physician usually relieve pressure by inserting a gloved hand inside the woman's vagina and moving the fetus off from the cord or the woman may be placed in a knee-chest position. This position help in moving the fetal head away from the cord.
Oxygen is also administered via mask to the mother to help in improving fetal oxygenation and to prevent anoxia. If the umbilical cord is visible through vagina and it has already been exposed to the room air, it should not be pushed back to prevent cord knotting and kinking that can lead to further complication. In such a case, a sterile saline clothing or compress is usually used to cover the exposed cord to prevent it from drying and to avoid atrophy of the umbilical blood vessels.
Medications (tocolytic) to decrease the intensity of the uterine contractions and to reduce pressure on the fetal head may also be prescribed. 
Lastly, the choice of delivery method will depends on several factors. If the cord prolapse is detected early before the rupture of membrane, a cesarian birth is usually indicated. If the by the time of cord prolapse, the cervix is fully dilated, the doctor may choose to deliver the baby as fast as possible by use of forceps. If the cervix is not fully dilated, the doctor may choose to relieve the pressure off the cord by inserting his or her hand into the vagina until delivery or in some cases, birth by cesarian may be performed.
However, any cord prolapse is an emergency case and immediate action is needed to prevent serious permanent injuries occuring to the baby.


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