Cord Prolapse

‘Yet sometimes the navel string falls down and comes before it; for which cause the child is in much danger of death… As soon as ‘tis perceived, you must immediately endeavor to put it back, to prevent the cooling of it, behind the child’s head, lest it be bruised… But sometimes, not withstanding all these cautions, and the putting back of it, it will yet come forth every pain; then without further delay, the chirurgeon must bring the child forth by the feet, which he must search for, tho the infant comes with the head; for there is but this only means to save the child’s life.’

• Francois Mauriceau

• The Diseases of Women with Child, and in Child-Bed. London: John Darby; 1663:255.

Prolapse of the umbilical cord is the classic obstetric emergency. It occurs when the membranes are ruptured and part of the cord lies below the presenting part of the fetus. Cord presentation is the same situation with intact membranes – a much rarer diagnosis. Over the past century the incidence of cord prolapse has decreased from about 1 in 150 to 1 in 500 deliveries; probably due to most malpresentations being delivered by caesarean section and more active management of the preterm fetus. Similarly, in well-equipped hospitals, the perinatal mortality has fallen over the past 50 years from 50–60% to 2–15%.

The risk to the fetus is the loss of umbilical blood flow to and from the placenta with consequent hypoxia due to physical compression of the blood vessels in the cord, or spasm of the blood vessels due to the colder temperature if the cord prolapses outside the vagina.