Condition

Umbilical Cord Prolapse

Editors: Esther Jolanda van Zuuren MD; Katharine DeGeorge MD, MS

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Background Information

Description

  • rare but emergent obstetric condition in which umbilical cord descends through cervix (in the presence of ruptured membranes) to a position either past the presenting part (overt prolapse) or alongside the presenting part (occult prolapse)
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Also Called

  • cord prolapse
  • prolapsed cord

Types

  • overt umbilical cord prolapse - cord has descended through the cervical os after membranes have ruptured
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  • occult cord prolapse - cord is alongside the presenting part after membranes have ruptured
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Epidemiology

Incidence/Prevalence

  • reported incidence about 0.1%-0.6% overall and varies based on patient populations
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  • STUDY SUMMARY
    about 0.12% incidence of umbilical cord prolapse in singleton deliveries in Sweden
    COHORT STUDY: Acta Obstet Gynecol Scand 2024 Feb;103(2):304

  • STUDY SUMMARY
    0.12% incidence in deliveries in United Kingdom
    COHORT STUDY: Int J Gynaecol Obstet 2004 Jul;86(1):29

  • STUDY SUMMARY
    0.12% incidence in deliveries in France
    COHORT STUDY: J Gynecol Obstet Biol Reprod (Paris) 2010 Oct;39(6):471

  • STUDY SUMMARY
    0.23% incidence in deliveries in North Jordan
    COHORT STUDY: J Obstet Gynaecol 2010 Apr;30(3):257

  • STUDY SUMMARY
    0.27% incidence in deliveries in Nigeria
    COHORT STUDY: Niger J Clin Pract 2009 Sep;12(3):232

Likely Risk Factors

  • maternal factors
  • fetal factors
    • malpresentation (such as breech presentation)
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    • abnormal lie (for example, transverse, oblique, or unstable)
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    • multiple gestation
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    • prematurity
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    • low birth weight, cutoffs vary
      • < 1,500 g
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      • < 2,500 g
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    • polyhydramnios
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    • congenital anomalies
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    • male sex
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      • STUDY SUMMARY
        male sex may be associated with increased risk of cord prolapse
        COHORT STUDY: Fetal Diagn Ther 2004 Jul-Aug;19(4):366

    • STUDY SUMMARY
      increased maternal age, higher parity, induction of labor, breech presentation and other malposition each associated with increased umbilical cord prolapse in labor with spontaneous rupture of membranes
      COHORT STUDY: Acta Obstet Gynecol Scand 2024 Feb;103(2):304

    • STUDY SUMMARY
      second-born twin, fetal weight < 2,500 g, prematurity, and breech presentation may be associated with development of umbilical cord prolapse
      CASE-CONTROL STUDY: Am J Obstet Gynecol 1994 Feb;170(2):613

    • STUDY SUMMARY
      abnormal umbilical cord insertion (velamentous or marginal) in second-born twin associated with increased risk of umbilical cord prolapse during delivery
      COHORT STUDY: BMJ Open 2021 Jun 16;11(6):e046616

  • manipulation during labor
    • STUDY SUMMARY
      amniotomy appears associated with increased risk for umbilical cord prolapse compared to spontaneous rupture of membranes
      COHORT STUDY: J Matern Fetal Neonatal Med 2014 Jan;27(1):14

    • placement of internal monitors
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    • external cephalic version
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    • manual rotation of fetal head
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    • amnioinfusion
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    • internal podalic version
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    • cervical ripening balloon catheter use
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  • other factors

Possible Risk Factors

  • conditions which may result in altered cord turgidity
    • true knots
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    • low cord content of Wharton jelly
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  • STUDY SUMMARY
    Bishop score > 8 may be associated with umbilical cord prolapse
    CASE-CONTROL STUDY: Arch Gynecol Obstet 2006 May;274(2):104

Factors Not Associated With Increased Risk

  • labor induction with prostaglandins
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Etiology and Pathogenesis

Causes

  • maternal, fetal, or iatrogenic clinical situations that prevent fetal engagement in pelvis (lower part of uterus and/or pelvic brim)
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Pathogenesis

  • lack of fetal engagement in maternal pelvis creates space for umbilical cord to prolapse
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  • upon amniotic membrane rupture, umbilical cord may
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    • prolapse in advance of fetal presenting part through pelvic outlet (overt cord prolapse)
    • prolapse alongside fetal presenting part through pelvic outlet (occult cord prolapse)
  • hypothesized abnormalities of umbilical cord (for example, thinness, rigidity, or lack of or reduction in Wharton jelly) may facilitate cord prolapse
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