Umbilical cord prolapse

What is a cord prolapse?

Umbilical cord prolapse (also known simply as ‘cord prolapse’) is when the umbilical cord enters your vagina. The cord may pass through the cervix before your baby does, or together with your baby. Cord prolapse can only happen once your waters have broken.

Why is cord prolapse an emergency?

The umbilical cord supplies nutrients and oxygen to your baby and clears waste products. Cord prolapse causes the umbilical cord to be compressed (squashed) between the baby and the birth canal. This reduces or stops the flow of blood in the cord. Cord prolapse may also cause the blood vessels to become narrower, which reduces the flow of oxygen to your baby. Your baby needs good oxygen supply and blood flow to survive, so prolapse that is not treated urgently is life-threatening.

Can cord prolapse be prevented?

Sometimes cord prolapse can be prevented; for example, before your waters have broken. If the cord is felt during a vaginal examination before your waters have broken, your doctors will not break your waters. If your baby’s head is high or its position is changing, your doctors will avoid breaking your waters if possible, or make sure to do it safely.

If your baby is lying on its side (known as transverse or oblique presentation), or if your baby’s position changes (known as mobile presentation), your midwife or doctor may recommend staying in hospital from 37 weeks of pregnancy.

If your baby is not head down you should go to hospital urgently if your waters break or you think you may be going into labour.

Are there risk factors for cord prolapse?

Risk factors for cord prolapse include:

• having had one or more babies before
• having a baby that weighs less than 2.5kg at birth
• having a baby with birth differences or defects (congenital anomalies)
• having more amniotic fluid than average
• having a baby that is not facing head down in the birth canal
• when the baby’s position changes late in pregnancy (mobile presentation)
• the second twin in a twin pregnancy

If you have any of these risk factors, your health team will check for cord prolapse every time you have a vaginal examination.

How is cord prolapse diagnosed?

Your midwife or doctor will do a vaginal examination to check for cord prolapse. If you are not yet in labour, they may use a speculum for this. If your baby’s heart rate is being monitored, a change in their heart rate may prompt your care provider to check for cord prolapse.

How is cord prolapsed managed?

Cord prolapse is a medical emergency and if you’re in hospital, many different health professionals will come quickly to help. An emergency caesarean section is usually recommended. You may need a general anaesthetic so your baby can be born more quickly. In some situations; for example, if you are moments away from your baby being born, a vaginal or assisted birth may be an option.

If you need a caesarean section, while your health team gets ready for this, your midwives and doctors will gently push the head of your baby off the cord to reduce the pressure on the cord. They may also insert a catheter and fill your bladder with water to help lift your baby’s head off the cord. If you are in labour, you might have medicines to stop your contractions. You will also be asked to lie with your knees to your chest or on your left side with your hips on a pillow.

What are the risks to the mother and baby if cord prolapse happens?

Cord prolapse is rare, occurring in around 0.1 — 0.6% of births. There is a risk of the baby suffering disability from not receiving enough oxygen for a period of time. If cord prolapse occurs the chance of the baby dying is extremely rare.

If your baby was born after cord prolapse, you might have had an unplanned caesarean birth, and you may feel the effects of some emotional trauma.

Is this likely to happen in future pregnancies?

No — you are unlikely to have a cord prolapse in a future pregnancy. Speak to your doctor or midwife if you need more reassurance, or about your options and their recommendations for your next pregnancy.

What if I feel traumatised?

After experiencing or witnessing an emergency in pregnancy or labour, you may feel emotional trauma or worry about future births. You may suffer from postnatal depression or post-traumatic stress disorder. Your midwife or doctor will find a time to discuss what happened, and answer any questions. You may find it helpful to talk to a social worker, and your midwife or doctor can arrange this. It’s important to get support if you need it.

Resources and support

For more information on umbilical cord prolapse read the Mater Hospital brochure.

If you or your partner may be suffering from birth trauma, contact a support organisation such as Australasian Birth Trauma Association or Gidget Foundation.