Umbilical cord prolapse is a medical emergency. It happens when the umbilical cord slips through your cervix, the opening to your uterus, and into your vagina. It puts your baby at great risk of serious disability or even death.

If you experience umbilical cord prolapse while you’re in the hospital, you will get immediate care and likely undergo an emergency cesarean section — if you aren’t already delivering your baby vaginally — in an attempt to save the baby’s life.

If umbilical cord prolapse happens outside a hospital setting, call 911 or your local emergency number immediately.

Though it can happen, umbilical cord prolapse is rare.

The umbilical cord contains three blood vessels that connect you and your baby. One vein carries food and oxygen from the placenta to your baby, and two arteries carry waste from your baby back to the placenta.

Sometimes the umbilical cord moves into the wrong place at the wrong time. That can cause events like umbilical cord prolapse. There are three types of umbilical cord prolapse:

  • Overt umbilical prolapse. The umbilical cord slips through your cervix and into your vagina after your membranes rupture and before your baby enters the birth canal.
  • Funic presentation. A loop of the umbilical cord moves into a position between your baby and the still-intact membranes.
  • Occult cord prolapse. The cord positions itself alongside your baby in the canal, but it’s not detectable by your doctor.

If the umbilical cord is squeezed or pinched, your baby may not get sufficient oxygen and their heart rate may slow down. This could lead to disability or death because of this lack of oxygen.

Umbilical cord prolapse is rare. Research shows that it happens in about 1 to 6 births per 1,000.

Most prolapses happen shortly after the membranes have ruptured.

One study estimates that 57 percent of prolapses occur within 5 minutes after the membranes have ruptured, and 67 percent occur within 1 hour of their rupture.

If you are at home, the most common symptom of umbilical cord prolapse is feeling the cord in your vagina after your water has broken. If you think you can feel the cord, call 911 or your local emergency number immediately.

If you are at the hospital, your doctor or midwife can detect cord prolapse when they check you manually and feel the cord or if your baby has an abnormal heartbeat.

Umbilical cord prolapse is rare. That said, a 2018 literature review listed several factors that may contribute to the medical event.

  • Atypical infant presentation (malpresentation). In one study, breech presentation accounted for 36.5 percent of deliveries in which prolapse occurred. Other malpresentations that may increase the risk of cord prolapse include transverse, oblique, and unstable lie.
  • Multiple babies. Twins or more may make it more likely that your baby lies in a way that could lead to prolapse.
  • Preterm labor. According to the American Academy of Family Physicians (AAFP), there’s more chance of prolapse if your membranes rupture prematurely and your baby is born at less than 37 weeks. But it’s important to note that umbilical cord prolapse occurs most often in term pregnancies.
  • Low birth weight. A smaller baby increases the chance of prolapse.
  • Polyhydramnios. Too much amniotic fluid can lead to prolapse.

The 2018 review points out that nearly 50 percent of umbilical cord prolapse incidents can be attributable to medical procedures such as amniotomy – when a healthcare professional ruptures the amniotic sac during labor. You may want to talk to your doctor or healthcare professional about this when discussing your delivery plan.

If you are at the hospital, your doctor may diagnose a prolapsed cord after seeing the cord or feeling it during a vaginal examination.

The second symptom of a prolapsed cord is an abnormal fetal heartbeat. The prolapsed cord may be pinched or squeezed between your baby’s body and the walls of the birth canal.

This pinching can lead to a lack of oxygen and a heartbeat that changes suddenly and recurrently. The 2018 review mentioned previously notes that in 67 percent of cases, these changes in your baby’s heartbeat may be the first sign of occult cord prolapse.

Early diagnosis can save your baby’s life.

If you are at home and you think that you have umbilical cord prolapse, go to the hospital, or call 911 or your local emergency number immediately. You can take some pressure off the umbilical cord by getting on your hands and knees with your pelvis up and head down.

When traveling by car or ambulance, change positions. Lie on your back and keep your hips elevated, use what is known as an exaggerated Sim’s position. Lie on your side, rolled forward toward your stomach with your chest down and your left leg bent and elevated with a pillow. Ask your doctor or healthcare professional about these positions.

If you are at the hospital, your doctor will deliver your baby immediately, usually by cesarean section. In rare cases, when it seems that a vaginal delivery will be faster, your doctor will guide you through the delivery.

While you’re being prepped for surgery, your doctor may try to take pressure off the cord in these ways:

  • inserting two fingers into the vagina and manually raising the part of your baby that’s pressing on the cord
  • filling your bladder with 500–700 cc or more of saline

No, you can’t predict or prevent umbilical cord prolapse. Most of the time, umbilical cord prolapse is an unexpected medical emergency.

The outlook for pregnancy with umbilical cord prolapse depends mainly on where the prolapse happens and the age and birth weight of your baby.

According to research, the mortality rate of an umbilical cord prolapse happening outside the hospital is quite high, but if it happens in the hospital, the rate drops to 3 percent.

Premature babies and babies with a low birth weight have twice the risk of dying from umbilical cord prolapse compared with babies with no umbilical cord prolapse.

If you have umbilical cord prolapse, your baby may have a low 5-minute Apgar score. The neonatal team will assess your baby after birth and administer resuscitation, which may include oxygen, chest compressions, or intubation.

Umbilical cord prolapse is a rare prenatal emergency. While an umbilical cord prolapse cannot be prevented, having an awareness of the possibility of prolapse, knowing what you can do to help you and your baby, and knowing what to expect can make it easier for you in the rare event that it happens.