A rare case report of umbilical cord prolapse in a second-trimester twin pregnancy: Diagnostic, management, and prognostic challenges.

INTRODUCTION

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.

CASE PRESENTATION: 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.

DISCUSSION: 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.

CONCLUSION

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.