As a mother-to-be, you may be a little scared or curious about childbirth. It's very normal. Even if you think everything will go well, sometimes complications can arise that we never thought possible. Today, we are talking about an emergency that can occur during childbirth, but is very rare, but requires immediate attention. This is called Umbilical Cord Prolapse.
Simply put, what does this umbilical cord sticking out mean?
Okay, before we understand this, let's first see what the umbilical cord is. As you know, the baby in the womb gets all the oxygen and nutrients it needs through this umbilical cord, which is connected to the baby's stomach from the mother's placenta. Simply put, this is the baby's lifeline .
In a normal birth, the baby comes out through the vagina first, and then the placenta comes out along with the umbilical cord. However, in a condition called ``Umbilical Cord Prolapse``, the opposite happens. That is, before the baby comes out, the umbilical cord comes down through the cervix and enters the vagina.
Imagine, what would happen if, when someone tries to get out of a narrow door, something like a pipe in their hand comes out first? When that person comes out, that pipe gets stuck, right? That's what happens here too.
When the umbilical cord descends before the baby is born, the baby's head or body can become trapped in the mother's cervix and vagina. This is why this is considered a very urgent and dangerous situation .
What happens when the umbilical cord gets stuck?
The umbilical cord is the main route that supplies oxygen and blood to the baby. So when it gets pinched, that blood supply is cut off completely.
- When the blood supply stops: The baby does not get the oxygen it needs.
- When the uterus contracts (when labor begins): This tightness increases.
- Exposure of the umbilical cord to air: The blood vessels in the umbilical cord shrink, further impairing blood flow.
These conditions can cause serious harm or even permanent disability to the baby. That's why doctors consider this an "obstetric emergency."
There are two main types of this condition.
Doctors see this in two main ways.
1. Overt prolapse: This occurs when the umbilical cord completely descends through the cervix and into the vagina before the baby is born.
2. Occult prolapse: Here, the umbilical cord does not come out before the baby. Instead, it comes down with the baby's body, that is, over the baby's head or shoulders, and gets stuck. This is a little harder to detect because it is not visible from the outside.
How common is this condition? And what are the symptoms?
This is not a very common condition. According to statistics, this condition occurs in about 1 in 300 births. Some new studies say that this condition has now decreased even further, to 1 in 1,000 births.
The main features to identify this are:
- After the water breaks: The doctor or nurse can feel or see the umbilical cord during a vaginal exam.
- Sudden decrease in the baby's heart rate: Doctors suspect this if the baby's heart rate suddenly slows down a lot (bradycardia) on the CTG machine, meaning it drops below 120 beats per minute.
This condition often occurs after the mother's water breaks. Studies show that more than 50% of prolapses occur within the first 5 minutes after the water breaks, and about 70% occur within an hour.
What are the risk factors for umbilical cord prolapse?
It's hard to pinpoint one specific cause for this. But there are several risk factors that increase your risk of developing this condition. If you have one or more of these, your doctor will pay special attention to it.
| Risk factor | Simple explanation |
|---|---|
| Fetal Presentation | Breech presentation : The baby's head is not down, but is positioned sideways or across the cervix. The head does not completely cover the cervix, allowing the umbilical cord to protrude. |
| Multiple Pregnancy | When having twins or triplets, the umbilical cord may descend after the first baby is born and before the second baby arrives. |
| Excessive amniotic fluid (Polyhydramnios) | If the amount of water (amniotic fluid) around the baby is too high, when the bag of waters breaks, the water can quickly push the umbilical cord down. |
| Premature Birth | If the bag of waters breaks before it's full, the cervix won't close properly because the baby is small. The umbilical cord can come down through that gap. |
| Abnormal umbilical cord | If the umbilical cord is too long, there is a greater chance of it coming down. |
| Placenta Previa | The placenta is located at the bottom of the uterus. |
| Number of children | This risk is higher for a mother who already has five or more children. |
In addition to this, things like low birth weight, excessive weight gain (macrosomia), and a doctor breaking the bag of water (amniotomy) can also increase the risk.
What complications can this cause?
As mentioned earlier, this is an emergency. If not treated immediately, the baby can have serious consequences because the baby's brain and body will be deprived of oxygen.
- Hypoxia: Lack of oxygen to the body.
- Birth asphyxia (HIE): Brain damage caused by lack of oxygen.
- Cerebral Palsy: Permanent movement disorders caused by damage to the brain.
- Permanent brain damage.
- Stillbirth: The unfortunate death of a baby in the womb.
This may sound scary to you, but remember, this is a very rare occurrence. And if this happens in a hospital, the medical team will immediately take action and do everything they can to save the baby.
How do doctors treat this?
Once an Umbilical Cord Prolapse is diagnosed, every second counts. The medical team's sole goal is to deliver the baby as quickly as possible.
1. Emergency C-section: In most cases, an emergency C-section is the safest and fastest way to save your baby. You will be taken to the operating theatre immediately.
2. Reducing pressure on the umbilical cord: During preparation for surgery, the medical team will try to reduce pressure on the umbilical cord. Several methods are used for this:
- Changing the mother's position: The mother is placed in a knee-to-chest position. This allows gravity to move the baby up a little, reducing pressure on the umbilical cord.
- Manually pushing the baby up: The doctor or a trained nurse places their hand in the vagina and gently pushes the baby's head up to release the umbilical cord. You will need to stay in this position until the cesarean section begins.
All of this is done to restore the baby's oxygen supply and safely deliver the baby.
Can a baby survive this condition?
Yes, it is definitely possible. If this situation occurs in a hospital, the chances of saving the baby are very high. The mortality rate in a hospital is very low, around 3%. But if something like this happens outside the hospital, for example during a home birth, the situation is very dangerous. Because there are no facilities to perform an immediate operation. That is why it is always important to deliver the baby in a hospital.
Is there a way to prevent this?
Unfortunately, there is nothing we can do to prevent an Umbilical Cord Prolapse. It is not possible to know this in advance during pregnancy, because the baby and the umbilical cord are constantly moving around inside the womb.
This is an unavoidable and rare emergency. All we need to do is be aware of the risk factors and choose a hospital to deliver. Then, if such an emergency occurs, your medical team will take the necessary steps quickly.
Take-Home Message
- Umbilical Cord Prolapse is when the umbilical cord comes into the vagina before the baby is born.
- This is a very serious medical emergency that disrupts the baby's oxygen and blood supply.
- Factors such as the baby's position (breech), twins, and increased water content can increase the risk.
- The main symptom is the umbilical cord becoming visible or palpable after the water breaks and the baby's heartbeat suddenly slowing down.
- The only treatment for this is to deliver the baby immediately, often through an emergency C-section.
- Although this cannot be prevented, delivering the baby in a hospital is more likely to save the life of the mother and baby in an emergency situation like this.
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