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 within approximately five minutes, long-term disability, fetal hypoxia, cerebral palsy or perinatal death can be the result. If cord prolapse occurs outside of a hospital setting, the probability of perinatal death or severe fetal asphyxia is very high.
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.Three Different Kinds of Cord Prolapse
There are three different kinds of prolapse:
- Overt umbilical cord prolapse: Overt cord prolapse occurs with rupture of membranes when the cord is in front of the presenting fetal part. In these cases, there is a need for immediate delivery. Often, doctors must elevate the presenting fetal part to prevent cord compression. Most of the cases that come into our law office involve overt umbilical cord prolapse.
- An occult prolapse is when the umbilical cord is down either in front of or next to the baby's head so it's getting pinched by the head as it descends into the pelvis. It can be laying on the front of the head, behind the cervix or next to the head.
- Funic presentation: This is the rare instance when the umbilical cord is in between the presenting fetal part and fetal unruptured membranes. The cord does not pass the opening of the cervix.
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.
We see a lot of cord compression cases where the umbilical cord becomes wrapped around the baby’s neck. The key to getting the baby out safely and avoiding a birth injury medical malpractice lawsuit is getting the problem resolved or getting the baby out quickly. Prompt diagnosis of a cord problem in time for a cesarean delivery is the cornerstone of management of cord prolapse. Far too often, nurses and OB's fail to take umbilical cord prolapse serious until it is far too late.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 cord or thin cord increases the risk of UCP. Finally, cord prolapse is more likely if the child is sunny side up or in an abnormal position.
A prolapsed umbilical cord is one of the most dangerous pregnancy complications because when the cord drops down into the birth canal in front of the baby (instead of behind) it gets compressed by the baby’s head or body. This compression of the umbilical cord can restrict or even completely cut off the supply of oxygen to the baby. Prolonged oxygen deprivation from cord compression can cause serious brain damage in a short time frame.
Prolapsed umbilical cord can be diagnosed through ultrasound imaging or a fetal doppler test which can show the placement of the cord prior to birth. Timely diagnosis of umbilical cord prolapse is very important to allow doctors the chance to intervene and avoid harm to the baby.
If there is an overt cord prolapse and the cord is coming past the baby's head, it is time for an emergency C-section. There is no wisdom in have the mother push or try a vacuum extraction. The standard of care requires the OB to do a C-section as soon as possible.
If prolapsed umbilical cord is diagnosed in advance doctors can deliver the baby via C-section to avoid any potential dangers from cord compression. Amnioinfusion can also be used to reduce pressure and avoid dangerous compression of the umbilical cord.
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.