Defying All Odds: Cord prolapse

cord prolapse ,a rare complication of induced labour

C, a 36-year-old teacher was in her third pregnancy. At 22 weeks of gestation, she was diagnosed to have gestational diabetes with a slight increase in the amniotic fluid. During the last trimester, her blood pressure was raised and she was admitted for induction of labour at 39 weeks of gestation.

A rare complication occurred during the induced birth. An hour after the foetal membranes were ruptured artificially, the electronic recording of the foetal heart rate (Cardiotocograph CTG) showed a sudden and rapid deceleration to a dangerous level. A vaginal examination revealed that a loop of cord had slipped out of the cervix into the vagina with the foetal head compressing it.

She was immediately put on the head-down-bottom-up (Trendelenburg) position to keep the baby’s weight off the cord and was rushed to the operation theatre where an emergency caesarean section was performed. C had a dangerous obstetric complication called umbilical cord prolapse, which occurs in about 0.5% of births.

What is umbilical cord prolapse?

The umbilical cord is a flexible tube-like structure that connects an unborn baby with the mother. It is the lifeline for the baby as it transports nutrients and oxygen to the baby and carries away the baby’s waste products. During pregnancy or delivery, an umbilical cord can prolapse when it drops through the opening of the womb ahead of the baby. The cord would be trapped and get compressed against the baby’s body during delivery. This would deprive the baby of the oxygen resulting in grave consequences.

What are the risk factors for umbilical cord prolapse?

Cord prolapse is more likely to occur if the following risk factors are present. They include:

  • Premature rupture of membranes
  • Polyhydramnios: excessive amniotic fluid surrounding the foetus
  • Premature birth
  • Breech
  • Multiple pregnancy

What are the signs of umbilical cord prolapse?

If the cord prolapses outside the vagina, the patient may be able to feel or see the cord.

Otherwise, the condition is detected during a vaginal examination. If the baby’s heart rate is being monitored when cord prolapse happens, there would be a rapid and sudden drop in the heart rate.

What are the consequences of umbilical cord prolapse?

Cord prolapse presents a great danger to the foetus. Deprivation of oxygen to the baby may cause brain damage and even result in a stillbirth. It is an obstetric emergency and the baby must be delivered immediately.

How should umbilical cord prolapse be managed?

To reduce the risk of the cord becoming compressed, the patient should be put in the Trendelenburg position. The midwife may insert a hand in to the vagina to lift the baby’s head to stop it compressing the cord and the baby should be delivered urgently, either by assisted delivery or by emergency caesarean section.

When C’s baby was delivered by caesarean section, he was pale, floppy with little response to stimulation.  His heart beat was 90 beats per minutes. His breathing was shallow and irregular. After resuscitation for 5 minutes with oxygen, his condition improved with a good Apgar score. He was sent to the neonatal intensive care unit (NICU) for further observation.

Much to C’s relief, her baby was discharged from the NICU 2 days later and has recovered well since.

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