All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
prolapse of the umbilical cord and small parts of the fetus
Medical expert of the article
Last reviewed: 07.07.2025
Prolapse of the umbilical cord loop and small parts of the fetus can be observed in the case of amniotic fluid leakage and the absence of a contact belt between the pelvis of the woman in labor and the presenting part. This occurs with a transverse fetal position, anatomically narrow pelvis, large fetus, extension insertions of the head, polyhydramnios, multiple pregnancy, premature birth. Prolapse of the umbilical cord is facilitated by its excessive length - over 75 cm.
The doctor's tactics in each specific case are individual and depend on many circumstances.
Prolapse of the umbilical cord, especially in case of cephalic presentation of the fetus, is a serious complication for the fetus. It is rare. According to most authors, presentation of the umbilical cord is detected in 0.6% of births, prolapse of the umbilical cord - in 0.14-0.4%. Perinatal mortality in case of prolapse of the umbilical cord reaches 4-16%. About 50% of all cases of prolapse of the umbilical cord are iatrogenic.
A distinction is made between presentation and prolapse of the umbilical cord. Presentation of the umbilical cord means that it is located below the presenting part, but with an intact amniotic sac. After the waters have broken, such a location of the umbilical cord is called prolapse. When the umbilical cord prolapses, its loops can be in the cervix, in the vagina, and even outside the genital slit. Prolapse of the umbilical cord contributes to fetal hypoxia, firstly, due to its cold irritation (bradycardia occurs in the fetus), and secondly, due to possible compression by the presenting part. The fetal head can completely compress the umbilical cord, stopping the blood flow and leading to the death of the fetus.
[ How to recognize cord presentation?
Diagnosis of cord presentation can be made by ultrasound and vaginal examination when the cervix has opened. Cord prolapse in cephalic presentation is characterized by a persistent change in the fetal heartbeat after the amniotic fluid has been released. The diagnosis is clarified by vaginal examination.
Management of labor in case of prolapse of the umbilical cord and small parts of the fetus
Prolapse of the pulsating loop of the umbilical cord with incomplete dilation of the cervix in cephalic or other types of fetal presentation requires delivery by cesarean section. If prolapse of the umbilical cord is detected with complete dilation of the cervix and the head located in the pelvic cavity, then an operation to apply obstetric forceps should be performed.
Prolapse of the umbilical cord in a woman in labor with a breech presentation of the fetus with full dilation of the cervix is less dangerous, since the umbilical cord is compressed only when the shoulder girdle and head of the fetus pass. In this case, labor through the natural birth canal is possible. However, with the appearance of signs of fetal distress and prolongation of labor, it is necessary to immediately begin an operation to extract the fetus.
The prolapse of the arm in cephalic presentation is very rare, most often it is presented next to the head. With small fetal sizes and normal pelvic sizes, this enlargement of the presenting part of the fetus usually does not interfere with its birth. If the insertion of the presenting part does not occur, then a cesarean section is performed.
The loss of an arm or leg in an oblique or transverse position of the fetus after the discharge of amniotic fluid is quite common. Currently, these positions of the fetus are an indication for a cesarean section. Therefore, in the case of the loss of small parts of the fetus and the absence of contraindications to operative delivery, a cesarean section is performed. The loss of small parts and the umbilical cord in the presence of a dead fetus is an indication for a feto-destroying operation.