Umbilical cord
Prolapsed umbilical cord

Author: Paul J. Kowalski, M.D. (see Authors page)

Revised: 19 May 2016, last major update May 2016

Copyright: (c) 2003-2016,, Inc.

PubMed Search: Prolapsed umbilical cord [title]
Cite this page: Prolapsed umbilical cord. website. Accessed September 22nd, 2017.
Definition / general
  • Cord prolapse occurs when the umbilical cord is expelled with, or prior to, the fetus during the fetal presentation process
  • Approximately 0.4 - 0.5% of deliveries are complicated by cord prolapse
  • A lack of fetal engagement within the uterus may create a space or gap that allows the umbilical cord to slip pass the fetus and into the birth canal
  • The umbilical cord can become markedly compressed when delivered with or before the fetus
  • Umbilical cord vascular occlusion and decreased placental venous return can severely limit fetal oxygenation capacity
  • Spontaneous or artificial rupture of membranes are a major cause
  • Other risk factors include those that perturb the appropriate filling of the pelvic space (engagement) by the fetus: an abnormal fetal lie/position, prematurity or low birth weight fetus, polyhydramnios, multiple gestation pregnancy, multiparity
  • Umbilical cord abnormalities, such as a long umbilical cord, are also a risk factor
Clinical features
  • Umbilical cord prolapse is an obstetrical emergency and is associated with perinatal mortality in 5 - 15% of cases
  • Sudden decreases in fetal heart rate
  • Moderate to severe variable decelerations on fetal heart tracing
  • A portion of umbilical cord may be detected on vaginal examination
  • Antenatal ultrasound may show cord herniation into the lower uterine segment / cervical canal
Case reports
  • Emergent cesarean section to prevent neurologic consequences or fetal death
Clinical images

Images hosted on Flickr:

Schematic representation of cord
prolapse preceding delivery

Gross description
  • Usually no gross abnormality is seen, unless complicated by another pathologic process, such as vascular thrombosis
  • If prolonged, the affected portion of prolapsed umbilical cord may appear dusky
Microscopic (histologic) description
  • Usually no microscopic abnormality is appreciated (unless complicated by another pathologic process)