A prolapsed umbilical cord (UCP or "overt cord prolapse") develops when the baby's umbilical cord drops or prolapses, through the open cervix into the vagina in advance of the presenting part of the baby. During an umbilical cord prolapse, the cord is often compressed by the fetus's shoulder or head.
The result is a baby struggling to get adequate blood and oxygen to its vital organs, most notably the brain. If there is not an immediate diagnosis and treatment, long-term disability, cerebral palsy or death can be the result.
This problem occurs in less than 1% of pregnancies. When it does happen, an umbilical cord prolapse is an abnormal condition and a very dangerous, obstetrical emergency. The mortality rate is as high as 50%. The treatment for a prolapsed umbilical cord is to try and release the prolapse in some way. This can be done by either tilting the patient back so that her head is lying beneath her feet. This is called the Trendelenburg position. There may also be medicinal remedies to stop the contractions.
If the baby is nonreassuring (basically in fetal distress), particularly if the child has fetal bradycardia (heart rate under 120), an emergency Caesarean section be performed.Why is UCP a Problem?
Compression is the concern. Prolapse of the cord seldom rarely leads to hypoxia or death. But a continuous compression can cause brain damage or death in a short period. Where there is a prolapse of the cord and the cord is in front of the baby, every time there is pressure like a contraction, it is like stepping on the hose. The cord intermittently compresses, decreasing the oxygen and nutrients coming to the baby.Diagnosis of Umbilical Cord Prolapse
The key to treating cord prolapse is to get out in front of the problem before it causes permanent damage to the child. This makes early diagnosis critical. The time interval from umbilical cord prolapse and delivery is a matter of life and death.
During the birthing process, an electronic fetal heart monitor to measure the baby's heart rate. More than half the time, cord prolapse is going to show up on the electronic fetal heart monitoring of the baby with heart decelerations. Often in the case of an umbilical cord prolapse, the baby will have bradycardia or severe variable decelerations. A cord prolapse is visible to the obstetrician very early in the continuum of labor and delivery. The doctor can also conduct a pelvic examination and may see the prolapsed cord, or palpate (feel) the cord with his or her fingers.Identifying Risks
But nurses should be able to identify patients at risk for UCP on admission. While every cord prolapse case cannot be predicted, many can. OBs and nurses should be able to identify interventions that put the patient at risk and plan accordingly. If they are not ready for the possibility of cord prolapse, it makes an appropriate response more difficult.
Cord prolapse is seen more frequently when the delivery is less before 36 weeks. Manipulations of the uterus or vacuum or forceps delivery also increase the risk. Certainly, a long or thin cord increases the risk of UCP. Finally, cord prolapse is more likely if they child is sunny side up or in any abnormal position.Getting a Lawyer for Your Malpractice Claim
If your child died or suffered a birth injury after a prolapsed umbilical cord that the doctors and nurses missed or did not deal with quickly, you may have a potential lawsuit for money damages. Call Ron Miller, Laura Zois or Rod Gaston today and let's talk about your options. We have 140 years of combined experience and a track record of success in wrongful death and catastrophic injury cases. If you are reluctant to contact a lawyer, perhaps you would like to start more slowly. We can discuss your case with you online via a free, no obligation case evaluation. We will also be willing to answer any questions about umbilical cord prolapse cases that you might have.