Prolapsed umbilical cord: Nursing process (ADPIE)

Tao Wang, G3T2P0A0L2 at 39 weeks of gestation, is a 36-year-old female client who is admitted to the labor and delivery unit after she started having contractions every 5 minutes, each lasting 60 seconds.

Ms. Wang’s obstetric history is uncomplicated and her first two children were born by spontaneous vaginal delivery.

She has no medical issues impacting this present pregnancy. A prolapsed umbilical cord is a rare but life-threatening obstetric emergency that occurs when the umbilical cord is abnormally positioned between the fetal presenting part and the cervix.

Normally, the fetal presenting part is its head, which during vaginal delivery descends through the birth canal first, followed by the upper body, and finally, the lower body, umbilical cord and placenta.

Now, the umbilical cord is a soft, tortuous bundle of blood vessels that is attached to the umbilicus of the fetus and connects to the center of the placenta.

The umbilical cord contains one vein that carries oxygenated blood and nutrients from the placenta to the fetus, as well as two arteries that carry deoxygenated blood and waste from the fetus to the placenta, and the urachus that drains the fetus’s urinary bladder.

Now, when the umbilical cord prolapses, it presents either ahead of the fetal presenting part, which is called an overt prolapse, or alongside the presenting part, referred to as an occult prolapse.

As a result, during vaginal delivery, the descending fetus compresses the umbilical cord, resulting in a decreased blood and oxygen supply to the fetus, which can cause fetal hypoxia.

Now, a prolapsed umbilical cord does not always have a clear cause, but there are some factors that may increase the risk of developing cord prolapse.

Nonmodifiable risk factors include maternal age of 35 or older, multiparity, multiple gestation, and polyhydramnios, as well as male sex, noncephalic fetal presentation, placenta previa, premature rupture of membranes, preterm labor, and low birth weight.

On the other hand, modifiable risk factors are often related to interventions that could displace the presenting part, including amniotomy or artificial rupture of membranes, external cephalic version, and placement of a cervical ripening balloon or intrauterine pressure catheter.