Cord Prolapse

Cord Prolapse


INTRODUCTION:

  • 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.

 TYPES:

  • 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
ETIOLOGY:
  • 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
DIAGNOSIS:
  • 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
MANAGEMENT:
CORD PROLAPSE:
Management protocol is to be guided by:
  • Baby living or dead
  • Maturity of the baby
  • Degree of dilatation of the cervix.

BABY LIVING:

  • 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

PROGNOSIS:

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
Exam Question
 
  • Least chances of cord prolapse are seen in Frank breech
  • Cord prolapse is most commonly associated with Transverse lie
  • Best treatment of Cord prolapse is  Cesarean section
  • Contracted pelvis, Hydramnios & Placenta previa are etiology of cord  prolapse
Don’t Forget to Solve all the previous Year Question asked on Cord Prolapse

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