Reproductive · Year 2 · from Reproductive
Case 3: Umbilical Cord Prolapse
Clinical Image
Source: Wikipedia - Umbilical cord prolapse - CC BY-SA 4.0
Case Presentation
A 31-year-old G3P2 at 38 weeks gestation presents with spontaneous rupture of membranes and a large gush of clear fluid at home. She has polyhydramnios noted on recent ultrasound, and the fetus is in an unstable lie (alternating transverse and breech presentations). Upon arrival at labor and delivery, the presenting part is not engaged (-3 station). During the admission examination, a pulsating loop of umbilical cord is palpated in the vagina ahead of the fetal presenting part. Fetal heart rate shows severe prolonged bradycardia at 60 bpm. Umbilical cord prolapse is diagnosed. The examining hand is kept in place to elevate the presenting part off the compressed cord. The patient is placed in knee-chest position and the bladder is filled with saline via Foley catheter to elevate the presenting part. The patient is rushed to the operating room for emergent cesarean delivery. The examiner's hand is maintained in position throughout transport and until abdominal delivery is accomplished, a total of 8 minutes from diagnosis to delivery. A vigorous infant is delivered with Apgar scores of 5 at 1 minute and 8 at 5 minutes. The infant does well without complications.
Key Learning Points
- Umbilical cord prolapse is an obstetric emergency where the cord descends through the cervix alongside or ahead of the presenting part, leading to cord compression and fetal hypoxia
- Risk factors include polyhydramnios, malpresentation (breech, transverse), unengaged presenting part, premature rupture of membranes, and multiparity
- Management requires immediate elevation of the presenting part off the cord (manually or by filling the bladder) and emergent delivery, usually by cesarean
- Diagnosis to delivery time is critical; the examiner's hand should remain in place elevating the presenting part until abdominal delivery is achieved