Umbilical Cord Prolapse and Compression
Insufficient Oxygen and Nutrients to Baby During Pregnancy & Birth
Nov 9, 2009
Compression of the umbilical cord, sometimes caused by umbilical cord prolapse, can be a serious problem that needs emergency attention at the time of birth to avoid serious complications. Fortunately, it is easily diagnosed and can be treated with prompt action by the medical staff attending the birth.
What Is Umbilical Cord Prolapse and Compression?
Umbilical cord compression occurs whenever the umbilical cord undergoes pressure, resulting in a decreased supply of blood and nutrients to the baby.
Umbilical cord prolapse is a type of compression that occurs just before birth when the cord slips into the birth canal and gets compressed by the descending baby. The pressure of the baby on the cord cuts off the blood and oxygen supply, necessitating emergency action to prevent stillbirth. This occurs in about 1 in 300 births and is more common for breech babies, those with a long umbilical cord and premature births.
Umbilical cord prolapse sometimes also occurs in twins, usually when the cord moves into the birth canal after the first baby has been born, trapping the cord between the two babies.
Compression can also occur when there is a nuchal cord, the wrapping of the umbilical cord around the baby's neck.
Dangers of Umbilical Cord Compression and Prolapse
When the umbilical cord becomes compressed, the heartbeat of the fetus will slow down due to a decrease in oxygen. If the compression is not relieved, this lack of oxygen can cause brain damage or even death of the fetus. Umbilical cord compression can be a serious emergency condition, but it is fortunately easily recognizable and treatable.
How Umbilical Cord Prolapse and Compression Is Diagnosed and Treated
The slowdown of the baby's heartbeat in cases of umbilical cord prolapse or compression is easily recognizable via a fetal Doppler and ultrasound and doctors can often rapidly diagnose the problem and determine what action to take.
Sometimes, when a pregnant woman's membranes rupture, when her waters break, she can feel if the umbilical cord is descending into the birth canal, indicating prolapse. In such cases, she should immediately head to the hospital so doctors can check the baby's heartbeat and determine whether the fetus is in danger of cord compression. A heartbeat of less than 100 beats per minute for more than a few minutes usually indicates a problem and doctors will generally move into a treatment plan at that point.
Treatment for minor umbilical cord compression or prolapse involves giving oxygen to the mother to increase oxygen flow through the cord. For more severe compression cases and for umbilical cord prolapse, the baby is carefully monitored to determine if it is in distress. Once fetal distress is detected, doctors often choose to perform an emergency C-section. Sometimes the situation never reaches this point, if the baby shifts and the prolapsed cord moves out of the birth canal, releasing the pressure, or if the doctor or midwife can manually shift the baby to cause this. These options are generally available if the mother's membranes have not yet ruptured. After her water breaks, a prolapsed cord is generally considered an emergency situation.
For information about other potential complications caused by umbilical cord mishaps, including knots and nuchal cord issues, see the article Fetal Umbilical Cord Problems.
Sources:
Cruikshank, D.W. Breech, Other Malpresentations, and Umbilical Cord Complications, Danforth's Obstetrics and Gynecology, 9th Edition. Philadelphia, Lippincott Williams and Wilkins, 2003
Morgan, B.L.G. and Ross, M.G. Umbilical Cord Complications. emedicine.com, March 1, 2006.
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