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# Umbilical cord prolapse

In cord prolapse the umbilical cord slips ahead of the baby after the waters break and gets squeezed, cutting the baby's oxygen. It is an emergency.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Cervix](https://durgical.com/en/anatomy/cervix-of-uterus/)
- [Vagina](https://durgical.com/en/anatomy/vagina/)
- [External os](https://durgical.com/en/anatomy/external-os-of-uterus/)
- [Lower uterine segment](https://durgical.com/en/anatomy/isthmus-of-uterus/)

## What it is

Descent of the umbilical cord alongside (occult) or in front of (overt) the presenting part after the membranes rupture, so that the cord is compressed or goes into spasm and fetal oxygen supply falls.

## Who gets it

Uncommon, occurring in roughly 1 to 6 per 1000 births, but associated with significant perinatal morbidity and mortality, mostly linked to delay in delivery. Outcomes are worse outside the hospital and where emergency caesarean is not quickly available.

## Causes

- Rupture of membranes when the presenting part does not fill the [pelvis](https://durgical.com/en/anatomy/region/pelvis/)
- Malpresentation: breech (especially footling), transverse or oblique lie
- Iatrogenic: amniotomy with a high presenting part, rotation or version manoeuvres

## Risk factors

- Breech or transverse lie, unstable lie
- Preterm birth and low birth weight
- Polyhydramnios
- Multiple pregnancy (especially the second twin)
- Multiparity and high, unengaged presenting part
- Long umbilical cord or low-lying placenta

## Pathophysiology

Once the cord lies below or beside the presenting part, contractions and fetal descent press it against the pelvis or cervix. Compression of the thin-walled umbilical vein and then the arteries, plus vasospasm from cold and handling, reduces fetal blood flow, causing hypoxaemia, bradycardia and, if not relieved quickly, acidosis and hypoxic-ischaemic brain injury.

## Classification

- Overt prolapse: cord visible or palpable in the vagina or beyond, ahead of the presenting part
- Occult prolapse: cord beside the presenting part, not palpable; suspected from the fetal heart rate
- Cord presentation (funic): cord below the presenting part with intact membranes

## Symptoms and signs

- Cord seen at the vulva or felt in the vagina on examination
- Sudden fetal bradycardia or deep variable decelerations right after the membranes rupture
- Mother may feel something in the vagina

## Red flags

- Persistent fetal bradycardia
- Cord pulsation weakening or absent on palpation
- Prolapse outside the hospital or far from an operating room
- Cord exposed to air and cold (vasospasm)

## Diagnosis

**Clinical**
Clinical: visualising or palpating the cord on vaginal examination, especially when performed promptly after spontaneous or artificial rupture of membranes with an abnormal fetal heart rate.

**Tests**
Continuous fetal heart rate monitoring shows variable decelerations or bradycardia. Cord blood gases after birth document the degree of acidosis.

**Imaging**
Ultrasound can show cord presentation before membranes rupture, but delivery must not be delayed for imaging once prolapse occurs.

## Differential diagnosis

- Other causes of acute fetal bradycardia: placental abruption, uterine rupture, maternal hypotension
- Uterine tachysystole
- Vasa praevia rupture (bleeding with fetal compromise)
- Compression of a nuchal cord without prolapse

## Goal of treatment

Relieve pressure on the cord immediately and deliver the baby as fast as safely possible, usually by emergency caesarean, unless vaginal birth is imminent.

## Treatment

**Acute**
Call for help; the examiner keeps a hand in the [vagina](https://durgical.com/en/anatomy/vagina/) lifting the presenting part off the cord; place the mother knee- [chest](https://durgical.com/en/anatomy/region/chest/) or in steep Trendelenburg; stop oxytocin.

**Acute**
Avoid handling the cord; if it is outside the vagina, keep it in place gently or cover it with warm moist gauze rather than pushing it back.

**Procedure**
Filling the bladder with saline through a catheter can lift the presenting part while transferring or preparing for caesarean; a tocolytic may reduce contractions.

**Surgical**
Emergency (category 1) caesarean delivery; operative vaginal delivery if the [cervix](https://durgical.com/en/anatomy/cervix-of-uterus/) is fully dilated and birth is imminent.

**Follow-up**
Continuous fetal monitoring until delivery; neonatal resuscitation team present; cord gases and assessment for hypoxic-ischaemic encephalopathy.

## Complications

- Fetal hypoxia and metabolic acidosis
- Hypoxic-ischaemic encephalopathy and cerebral palsy
- Stillbirth or neonatal death
- Maternal risks of emergency surgery or rapid instrumental birth

## Prognosis

With a short interval from diagnosis to delivery in hospital, most babies survive without injury. Prognosis worsens with prolonged delay, prolapse outside hospital, prematurity and low birth weight.

## Prevention

- Avoid amniotomy when the presenting part is high or not engaged
- Vaginal examination promptly after membrane rupture in women at risk
- Hospital admission near term for unstable or transverse lie

## Test yourself

Think of the answer, then tap the question to see it.

## Which fetal heart rate finding right after membrane rupture suggests cord prolapse?

Sudden bradycardia or severe variable decelerations.

## What is the immediate manual manoeuvre for overt cord prolapse?

Elevate the presenting part off the cord with a hand in the vagina and keep it there until delivery.

## Which maternal positions help relieve cord compression?

Knee-chest position or steep Trendelenburg (head down).

## Should a prolapsed cord be pushed back into the uterus?

No. Handle it as little as possible and keep it warm and moist; delivery is the treatment.

## What are two major risk factors for cord prolapse?

Malpresentation (breech, transverse lie) and polyhydramnios; also prematurity and multiple pregnancy.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/umbilical-cord-prolapse/)

## Related conditions

- [Premature rupture of membranes (PROM and PPROM)](https://durgical.com/en/conditions/premature-rupture-of-membranes/)
- [Breech and other malpresentations](https://durgical.com/en/conditions/breech-and-other-malpresentations/)
- [Multiple pregnancy and twin–twin transfusion syndrome](https://durgical.com/en/conditions/multiple-pregnancy-and-twin-twin-transfusion-syndrome/)
- [Amniotic fluid disorders (polyhydramnios, oligohydramnios)](https://durgical.com/en/conditions/amniotic-fluid-disorders/)
- [Preterm labour and birth](https://durgical.com/en/conditions/preterm-labour-and-birth/)
- [Intrapartum fetal compromise (non-reassuring fetal status)](https://durgical.com/en/conditions/intrapartum-fetal-compromise/)
- [Perinatal asphyxia and hypoxic-ischaemic encephalopathy](https://durgical.com/en/conditions/perinatal-asphyxia-and-hypoxic-ischaemic-encephalopathy/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Umbilical Cord Prolapse](https://www.msdmanuals.com/professional/gynecology-and-obstetrics/abnormalities-and-complications-of-labor-and-delivery/umbilical-cord-prolapse) (MSD Manual Professional Edition, 2024); [Fetal Monitoring During Labor and Delivery](https://www.msdmanuals.com/professional/gynecology-and-obstetrics/labor-and-delivery/fetal-monitoring-during-labor-and-delivery) (MSD Manual Professional Edition, 2024).

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Source: https://durgical.com/en/conditions/umbilical-cord-prolapse/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/umbilical-cord-prolapse/