Umbilical cord prolapse occurs when the cord slips out through the cervix, before the baby, after the bag of water has broken. When cord prolapse happens, the baby must be delivered as quickly as possible. If the cord is pinched or squeezed between the fetus and vaginal wall, no oxygen is delivered to the baby.
Cord prolapse is more common when the baby is not in the head-down position. When the round head is covering the cervix, the cord usually cannot come out first. You can imagine that if the more irregularly shaped baby’s butt or feet were over the cervix, the cord has more space for slipping through. Cord prolapse can also occur at the time of amniotomy (when the doctor breaks a patient’s bag of water) if the head is not pressing down against the cervix firmly. Similarly, if excessive amounts of amniotic fluid, or polyhydramnios, are present, the head may not be positioned well against the cervix and a loop of umbilical cord can slip through.
With a cord prolapse, the best course of action is an immediate cesarean delivery.
ON THE BED WITH MY PATIENT
As an ob-gyn, I find there’s an art to doing cervical exams with your fingers–you are actually assessing a part of a patient’s body without directly visualizing it. This skill comes only with experience–in our case, after thousands and thousands of exams. Along the way, you also become more proficient at knowing what part of the baby’s body you are touching. It feels different to be touching a baby’s head than a butt or an ear or an umbilical cord. Honestly, everything does feel kind of soft and slippery, but after enough practice, you can tell what’s what.
During my first year in private practice, I remember a patient who came into the hospital in active labor after spontaneously having broken her bag of water. Suddenly, we could see on the monitor that the baby’s heart rate was dropping rapidly … and staying down. When I did a cervical exam to see what was going on, I felt the baby’s head, but I also felt a loop of cord along the side of her cervix, and I could tell it was about to slip farther down. I could feel the blood pulsing through the cord, so I was 100 percent certain that it was the umbilical cord.
I called out for an emergency cesarean delivery, then jumped up on my patient’s bed and tried to keep the umbilical cord from slipping farther out by keeping my hands in her vagina, while the nurses ran down the hall, pushing my patient and me on the bed together toward the operating room. She may have been okay without my amateur heroics, but it was my first year in private practice and I acted out of instinct. At any rate, she definitely needed the emergency cesarean, and we ended up with a beautiful, healthy baby at the end.Alane
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