fetal lie tends to result in space below the baby in the maternal pelvis, which can then be occupied by the cord. polyhydramnios, or an abnormally high amount of amniotic fluid prematurity: likely related to increased chance of malpresentation and relative polyhydramnios. low birth weight: usually described as <2500g at birth, though some studies will use <1500g. Cause is likely similar to those for prematurity. multiple gestation, or being pregnant with more than one baby at a given time: more likely to occur in the baby that is not born first. spontaneous rupture of membranes: about half of prolapses occur within 5 minutes of membrane rupture, two-thirds within 1 hour, 95% within 24 hours. treatment associated factors: artificial rupture of membranes placement of internal monitors (for example, internal scalp electrode or intrauterine pressure catheter) manual rotation of fetal head Diagnosis Umbilical cord prolapse should always be considered a possibility when there is a sudden decrease in fetal heart rate or variable decelerations, particularly after the rupture of membranes. With overt prolapses, the diagnosis can be confirmed if the cord can be felt on vaginal examination. Without overt prolapse, the diagnosis can only be confirmed after a cesarean section, though even then it will not always be evident at time of procedure. Classification There are three types of umbilical prolapse that can occur: overt umbilical cord prolapse: descent of the umbilical cord past the presenting fetal part. In this case, the cord is through the cervix and into or beyond the vagina. Overt umbilical cord prolapse requires rupture of membranes. This is the most common type of cord prolapse. occult umbilical prolapse: descent of the umbilical cord alongside the presenting fetal part, but has not advanced past the presenting fetal part. Occult umbilical prolapse can occur with both intact or ruptured membranes. funic (cord) presentation: presence of the umbilical cord between the presenting fetal part and fetal membranes. In this case, the cord has not passed the opening of the cervix. In funic presentation, the membranes are not yet ruptured. Management The typical treatment of umbilical cord prolapse in the setting of a viable pregnancy involves immediate delivery by the quickest and safest route possible. This usually requires cesarean section, especially if the woman is in early labor. Occasionally, vaginal delivery will be attempted if clinical judgment determines that is a safer or quicker method. Other interventions during management of cord