Clinical meaning
Umbilical cord prolapse occurs when the cord descends through the cervix ahead of or alongside the fetal presenting part after membrane rupture, resulting in cord compression between the fetus and maternal pelvis. This compression occludes umbilical blood flow, causing acute fetal hypoxia and bradycardia. Overt prolapse (cord visible at introitus or palpable in vagina) is an obstetric emergency requiring delivery within minutes. Occult prolapse (cord compressed alongside the presenting part but not palpable) presents as variable or prolonged decelerations on fetal monitoring. Without rapid intervention, sustained cord compression leads to fetal acidosis, hypoxic-ischemic encephalopathy, and death.
Diagnosis & workup
Diagnostics & workup: - Continuous electronic fetal heart rate monitoring (prolonged decelerations, variable decels) - Sterile vaginal exam (palpable pulsating cord in vagina) - Visualize cord at introitus if overt prolapse - Assess fetal heart rate pattern for cord compression pattern - Determine cervical dilation and fetal station - Assess for complete vs. incomplete cord prolapse