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Chapter 12 - Umbilical Cord Prolapse

Published online by Cambridge University Press:  16 October 2025

By
Lo Wong  and
Tak Yeung Leung
Edited by
Sir Sabaratnam Arulkumaran
Sir Sabaratnam Arulkumaran
Affiliation:
St George's Hospital Medical School, University of London
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Summary

Umbilical cord prolapse is an obstetrical emergency with an incidence of 1 to 6 per 1000 pregnancies, which is associated with high perinatal mortality. This chapter addresses several important aspects of cord prolapse. The definition of cord prolapse varies in the literature, and the term ‘occult cord prolapse’ is misleading. To address this, cord prolapse, cord presentation and compound cord presentation should be classified based on their positional relationship. Urgent delivery by cesarean delivery is the main treatment, except in cases where vaginal delivery is imminent. The urgency of delivery depends on the fetal heart rate pattern, with bradycardia cases requiring the most immediate intervention. Cord arterial pH declines significantly during bradycardia-to-delivery intervals, indicating potential irreversible pathology. Various manoeuvres can be used to relieve cord compression before caesarean delivery and an algorithm was proposed to guide the acute management of cord prolapse.

Keywords

angle of progressionbradycardia-to-delivery intervalcaesarean deliverycord presentationdecision-to-delivery intervalfetal distressknee-chest positiontransperineal sonographyTrendelenburg positionumbilical cord prolapse

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Chapter
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Best Practice in Labour and Delivery , pp. 149 - 158
Publisher: Cambridge University Press
Print publication year: 2025

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