- 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
- 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:
- Done on
- Premature membranes rupture
- Labor in malpresentation, twins, hydramnios or vertex presentation
- Done before and after amniotomy
- 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
- 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%.
- Operative delivery :Risk of anesthesia, blood loss and infection
- 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