This blog describes how umbilical cord prolapse can occur; how it should be managed; why it is a medical emergency and also considers why outcomes for babies who have suffered from cord prolapse are improving when the incidence of cord prolapse has not.
The umbilical cord connects an unborn baby with the mother. Running from the baby’s tummy to the mother’s placenta, the cord transfers blood full of nutrients and oxygen from the mother to the baby and carries waste products away. During pregnancy or when a baby is being born, an umbilical cord prolapse can arise when the umbilical cord descends through the opening of the womb before the baby does. As the baby follows during a vaginal delivery, the cord then becomes trapped and compressed between the baby and the mother and the baby no longer receives the oxygenated blood that it needs to survive.
As such, cord prolapse is considered an obstetric emergency and the Royal College of Obstetricians and Gynaecologists (RCOG) first published guidelines in 2008 for recommended action when a cord prolapse occurs, and these guidelines were then updated in 2014. I have spent some time reading these guidelines in the course of my work and have been involved in investigating clinical negligence cases where cord prolapse was managed well and other cases where it sadly was not and the very different outcomes that can occur respectively, and therefore wanted to share some key points from the guidelines.
Thankfully umbilical cord prolapse is relatively rare, reported to occur in about one in 200 births but there are a number of factors which make cord prolapse more likely, for example when the waters break early; labour starts prematurely; the baby’s head is not pointing downwards; there is more than one baby; the baby is small; there is more water than usual surrounding the baby; and when the placenta is lying low in the womb.
Some women do not notice any signs when a cord prolapse has occurred. Others are able to feel or see the cord in the vagina. If the baby’s heart rate is being monitored when the cord prolapse arises, there may be a drop in the heart rate as the baby begins to struggle with the lack of oxygen.
According to the RCOG guidelines, if you ever find yourself in a position of thinking that cord prolapse has occurred, you should phone 999 for an emergency ambulance and say that you are pregnant and you think you have a prolapsed umbilical cord.
To reduce the risk of the cord becoming compressed, you may then be advised to get onto your knees with your elbows and hands on the floor, and then bend forward so that your bottom is in the air. The RCOG advise that you should remain in this position until the ambulance or midwife arrives.
The ambulance should then take you to the nearest consultant-led maternity hospital or unit that can provide full care. If cord prolapse is confirmed then the baby will be born as soon as possible, either by assisted delivery or emergency caesarean section. A midwife may insert a hand in to the vagina to lift the baby’s head and to stop it compressing the cord.
Umbilical Cord Prolapse is a potentially life threatening event and it is important to get the baby out quickly. Although a healthy baby will compensate for a short time, prolonged squeezing of the cord may lead to the baby’s brain being starved of oxygen, resulting in brain damage.
As a lawyer acting for children who have suffered from brain damage as a result of the mismanagement of cord prolapse, I was pleased to read that although the incidence of cord prolapse has not changed in a century, the outcomes for babies whose births are complicated by cord prolapse have improved greatly. This is thought likely to be due to prompt diagnosis and management of cord prolapse, following guidelines for recommended practice, more rapid delivery by caesarean section once a prolapsed cord has been diagnosed and improvements in intensive care for newborn babies.
The management of cord prolapse is also an area where it is mandatory for labour wards to have specific guidelines for management and training drills and I hope that this will mean the numbers of adverse outcomes for babies from this complication will continue to reduce.