Images in Clinical Medicine

Umbilical-Cord Prolapse at 29 Weeks' Gestation

Michael Belfort, M.D., Ph.D.

N Engl J Med 2006; 354:e15April 20, 2006

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A 23-year-old woman (gravida 1, para 0) was admitted at 29 1/7 weeks' gestation because of preterm premature rupture of the membranes. Her membranes had ruptured four days earlier, as confirmed by speculum examination. Continuous electronic monitoring of the fetal heart rate had been initiated at the time of admission and showed a reactive tracing and occasional mild, variable decelerations. Color Doppler ultrasonography showed the umbilical cord prolapsing through the cervix; the cervix was not markedly dilated. The woman underwent an emergency cesarean section, and an 1180-g female infant was delivered. The infant's Apgar scores were 6 at one minute and 8 at five minutes. Analyses of umbilical-cord arterial blood gases showed a pH of 7.325 and a base excess of −2.3 mEq per liter. The baby was transferred to the newborn intensive care unit and did well.

Michael Belfort, M.D., Ph.D.
St. Mark's Hospital, Salt Lake City, UT 84124

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