Obstetrics

Umbilical Cord Prolapse

Umbilical cord prolapse is descent of the cord past or alongside the presenting part after membrane rupture, so the presenting part and contractions compress it and fetal oxygenation fails.

Definition

Cord prolapse is descent of the umbilical cord through the cervix alongside the presenting part (occult) or past it (overt), with the membranes ruptured. Cord presentation is the cord lying between the presenting part and the cervix, with membranes intact or ruptured. The distinction matters: prolapse is an emergency, presentation is a warning.

First principles

Prolapse needs ruptured membranes and a gap beside the presenting part

Cord presentation is the cord lying between the presenting part and the cervix, membranes intact or not. Prolapse is descent alongside (occult) or past (overt) the presenting part once the membranes have ruptured. An engaged head fills the pelvis and blocks that route; a high, breech or transverse presentation leaves it open. The Royal College of Obstetricians and Gynaecologists (RCOG) Green-top Guideline No. 50 (GTG50) covers pregnancies from 23+0 weeks onwards. Its RCOG web summary says 22 completed weeks instead, so use the guideline PDF, which is the citable text.

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