Fathallah Ibrahim, Al-Talep Ahmed, Alajrd Abd Alrhman, Al-Ali Majd
Faculty of Medicine, Homs University, Homs, Syria.
Faculty of Medicine, Homs University, Homs, Syria.
Int J Surg Case Rep. 2025 Aug;133:111578. doi: 10.1016/j.ijscr.2025.111578. Epub 2025 Jun 27.
Umbilical cord prolapse is a rare obstetric emergency that threatens fetal oxygenation and may require an emergency cesarean delivery, occurring in approximately 1 to 6 per 1000 pregnancies. Risk factors include multiple gestation, polyhydramnios, and low birth weight. Ultrasound plays a vital role in improving neonatal outcomes and prolonging pregnancy in high-risk cases. However, UCP in a second-trimester twin pregnancy is highly rare.
A 22-year-old primigravida at 19 + 3 weeks with a twin pregnancy presented with umbilical cord prolapse. Examination revealed 10 cm of cord prolapsed vaginally. Ultrasound showed breech presentation of the first twin and cephalic of the second, both with cardiac activity. Emergency cesarean was performed, but both fetuses were non-viable. The patient healed and left the hospital the next day.
Umbilical cord prolapse is classified as overt or occult. Overt prolapse occurs when the cord descends before the presenting part and is diagnosed clinically, while occult prolapse involves the cord slipping alongside and is suspected via abnormal fetal heart rate patterns. Management depends on membrane status; in cases of rupture, emergency cesarean is often required. Diagnosis relies on identifying a pulsatile cord during vaginal examination, as ultrasound is often insufficient.
This case emphasizes the critical role of early diagnosis and prompt intervention in managing UCP, particularly in rare cases like second-trimester twin pregnancies. Obstetricians should remain vigilant in high-risk cases and consider immediate ultrasound evaluation and coordinated multidisciplinary care to minimize maternal and fetal complications.
脐带脱垂是一种罕见的产科急症，会威胁胎儿的氧供，可能需要紧急剖宫产，其发生率约为每1000例妊娠中有1至6例。危险因素包括多胎妊娠、羊水过多和低出生体重。超声在改善高危病例的新生儿结局和延长孕周方面起着至关重要的作用。然而，孕中期双胎妊娠合并脐带脱垂极为罕见。
一名22岁初产妇，孕19 + 3周，双胎妊娠，出现脐带脱垂。检查发现有10厘米脐带经阴道脱垂。超声显示第一个胎儿为臀位，第二个胎儿为头位，两者均有心跳。行急诊剖宫产，但两个胎儿均未能存活。患者术后恢复良好，次日出院。
脐带脱垂分为显性和隐性。显性脱垂是指脐带在胎先露之前下降，可通过临床诊断，而隐性脱垂是指脐带旁滑，可通过异常的胎儿心率模式怀疑。处理方法取决于胎膜情况；胎膜破裂时，通常需要紧急剖宫产。诊断依靠阴道检查时发现搏动的脐带，因为超声检查往往不够充分。
本病例强调了早期诊断和及时干预在处理脐带脱垂中的关键作用，特别是在孕中期双胎妊娠等罕见病例中。产科医生在高危病例中应保持警惕，考虑立即进行超声评估并进行多学科协作护理，以尽量减少母婴并发症。
