CORD PROLAPSE

• Umbilical cord prolapse occurs when the umbilical cord comes out of the uterus with or before the presenting part of the fetus.
• It is a relatively rare condition and occurs in fewer than 1% of pregnancies.
• Cord prolapse is more common in women who have had rupture of their amniotic sac.

 

• Occult prolapse:Cord is placed by the side of the presenting part and is not felt by the fingers on internal examination.
• Cord presentation:Cord is slipped down below the presenting part and is felt lying in the intact bag of membranes
• Cord prolapse:The cord is lying inside the vagina or outside the vulva following rupture of the membranes

• Malpresentations:transverse (5–10%) and Frank breech (3%)
• Contracted pelvis
• Prematurity
• Twins
• Hydramnios
• Placental factor:placenta previa
• Iatrogenic: Low rupture of the membranes, manual rotation of the head, ECV, IPV
• Stabilizing induction

• Occult prolapse:Persistence of variable deceleration of fetal heart rate pattern 
• Cord presentation:Pulsation of the cord through the intact membranes.
• Cord prolapse:The cord is palpated directly by the fingers
• USG for cardiac movements or auscultation for FHS

ANTICIPATION AND EARLY DETECTION:

Internal examination: 

• Done on 

• Premature membranes rupture
• Labor in malpresentation, twins, hydramnios or vertex presentation

• Done before and after amniotomy

Surgical induction:

• If the head is not engaged prior to low rupture of the membranes

• Baby living or dead
• Maturity of the baby
• Degree of dilatation of the cervix.

• Definitive treatment:Cesarean section

Immediate safe vaginal delivery is possible:

• If the head is engaged:Ventouse delivery
• If breech:Internal version followed by breech extraction
• Immediate safe vaginal delivery is not possible:
• First aid management: ? pressure on the cord
• Stop any oxytocin infusion
• Bladder filling(400–750 mL):done to raise the presenting part off the compressed cord till delivery
• To lift the presenting part off the cord by gloved fingers introduced into the vagina
• Postural treatment:Sims’ position ,Trendelenburg or knee-chest position
• To replace the cord into the vagina to minimize vasospasm due to irritation
• BABY DEAD: Labor is allowed to proceed awaiting spontaneous delivery

Fetal:

• Risk of anoxia(more in vertex presentation)
• Delivery between within 10–30 minutes the fetal mortality can be reduced to 5–10%.
• Perinatal mortality: 15–50%.

Maternal:

• Operative delivery :Risk of anesthesia, blood loss and infection