Umbilical Cord Prolapse
What Is Umbilical Cord Prolapse & Umbilical Cord Compression?
During a vaginal delivery, the baby is usually delivered first. However, sometimes the umbilical cord is delivered before the baby comes out. When this occurs, the medical condition is called umbilical cord prolapse. An umbilical cord prolapse can create a dangerous situation in the delivery room. This is because the cord can become compressed as the baby passes through the birth canal. The umbilical cord is responsible for providing important nutrients to the baby, including blood and oxygen. Below are the three types of umbilical cord prolapse:
Overt Umbilical Cord Prolapse: When the umbilical cord descends before the baby. This is the most common type of umbilical cord prolapse.
Occult Umbilical Cord Prolapse: For an occult prolapse, the cord is delivered beside the baby.
Funic Cord Presentation: The umbilical cord is located between the presenting fetal part and fetal membranes. The cord has not passed the opening of the cervix.
Doctors are responsible for closely monitoring a baby when there is evidence of an umbilical cord prolapse. Failure to do so can lead to a brain injury in the baby. Tools such as the electronic fetal heart monitor can alert doctors of problems with a cord prolapse through a sudden drop in the baby’s heart rate on the fetal strips.
How Umbilical Cord Prolapse Can Lead To A Brain Injury (Hypoxic Ischemic Encephalopathy)
One of the most serious fears of umbilical cord prolapse is a lack, or reduced level of blood and oxygen for the baby. Therefore, doctors must correctly diagnose umbilical cord prolapse and act consistent with the standard of care. Failure to do so can lead to a brain injury.
When the umbilical cord delivers before the baby, cord compression can occur. This is because, as the uterus contracts, the baby is moved down the birth canal. As the baby moves down, more and more pressure can be placed on the umbilical cord. The baby’s head, or buttocks/feet in a breech delivery can place considerable pressure on the umbilical cord. This can lead not only to fetal hypoxia and hypoxic ischemic encephalopathy (HIE), but also fetal death.
Doctors can be alerted to serious problems when the electronic fetal heart monitor moves from a “reassuring” reading to an “non-reassuring” reading. For example, a sudden drop in the fetal heart rate for a considerable amount of time (bradycardia) can be the result of a blood and oxygen problem for the baby. In addition, the strips may reveal late decelerations and minimal variability, among other things. Failure to notice these signs, and take appropriate action, can lead to serious injury in the baby, like HIE and a subsequent cerebral palsy diagnosis, or death.
Umbilical Cord Prolapse Signs And Symptoms
As already mentioned, the fetal heart monitor can help determine whether there is an umbilical cord prolapse, and subsequent cord compression through a sudden decrease in the baby’s baseline heart rate. In addition, doctors can perform a vaginal examination to determine if the umbilical cord is being delivered ahead of the baby. With some deliveries, the umbilical cord can be seen being delivered before the baby.
Risk Factors For Umbilical Cord Prolapse
There are certain factors which can increase the risk for an umbilical cord prolapse. The following are some of the common risk factors:
Breech Position: Breech position is a type of delivery in which the baby is delivered buttocks/foot first. Umbilical cord prolapse increases with the footling breech because the cord can slip past the foot and deliver before the baby.
Artificial Rupture Of Membranes
Polyhydramnios: When too much amniotic fluid surrounds the baby
Treatment And Management Of Umbilical Cord Prolapse
As mentioned above, fetal heart readings can help alert doctors and nurses that an umbilical cord prolapse might be present during a delivery. A non-reassuring strip can mean that the baby is no longer tolerating the vaginal delivery and needs help.
Doctors must realize that an umbilical prolapse is a delivery room emergency. If the cord is present doctors do not want to handle the cord due to the chance of restricting the flow of blood and oxygen. With that said, doctors can move the mother to a head down position, with her knees to her chest to try and resolve the cord prolapse.
Because of the threat of cord compression, a C-Section will be the general course of action for an umbilical cord prolapse. When the decision to perform the C-Section is made because other methods to resolve the cord compression have failed, doctors must perform the C-Section as soon as possible because if the baby’s fetal reserves are depleted and there is a deprivation of blood and oxygen, fetal hypoxia, or hypoxic ischemic encephalopathy can occur.
Was Your Baby’s Umbilical Cord Delivered First And Now You Have Been Told The Baby Has A Brain Injury?
Umbilical cord prolapse is a delivery room emergency and must be treated as such. The chances of a bad result for the baby increase when doctors do not pay attention to the signs which suggest that the umbilical cord has become compressed. For example, with a footling breech delivery, the chances of an umbilical cord prolapse increase because the cord can slip down past the foot. The electronic fetal heart monitor in many instances will display concerns regarding how well the baby is holding up to a vaginal delivery (sudden decrease in heart rate, late decelerations, minimal variability, etc.…). Failure of doctors to notice the signs of fetal distress due to umbilical cord compression and take the appropriate steps to prevent a brain injury in the child, can form the basis of a medical malpractice cause of action.
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