Successful Vaginal Delivery in Overt Cord Prolapse: A Rare Case Report with Review of Literature and Ayurvedic Perspective

Abstract

Umbilical cord prolapse is a rare but potentially life-threatening obstetric emergency that may rapidly lead to fetal hypoxia due to compression of the umbilical cord. Prompt diagnosis and immediate obstetric intervention are the key determinants of favorable maternal and neonatal outcomes. Although emergency cesarean section is the preferred mode of delivery in most cases, expedited vaginal delivery may be the safest option when the cervix is fully dilated and delivery is imminent. A 31-year-old multigravida (G4P3L3A0) woman at 37 weeks and 6 days of gestation presented in active labor with an uneventful antenatal history. General examination, routine laboratory investigations, and obstetric ultrasonography were within normal limits. During the second stage of labor, spontaneous rupture of membranes occurred at full cervical dilatation, followed by overt umbilical cord prolapse. Fetal heart rate decreased to 105 beats per minute. Immediate obstetric management was initiated, and considering complete cervical dilatation with imminent delivery, rapid vaginal delivery was performed. A live male neonate weighing 2.3kg was delivered with Apgar scores of 6/10 at one minute and 8/10 at five minutes. The placenta was delivered spontaneously and completely. No episiotomy was required. The postpartum period remained uneventful, and both mother and baby were healthy during the 15-day follow-up. This case emphasizes that early recognition, rapid clinical decision-making, and timely vaginal delivery can result in favorable maternal and neonatal outcomes even in overt umbilical cord prolapse. The case is further discussed in light of current obstetric evidence and the Ayurvedic concept of Prasava Upadrava and Apana Vayu.