Tag: Cord Prolapse

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

Cord Prolapse

CORD PROLAPSE

Q. 1

A 38 week pregnant primigravida with breech presentation is found to have cord prolapse. LEAST chances of cord prolapse are seen in:

 A

Frank breech

 B

Complete breech

 C

Footling

 D

Knee

Q. 1

A 38 week pregnant primigravida with breech presentation is found to have cord prolapse. LEAST chances of cord prolapse are seen in:

 A

Frank breech

 B

Complete breech

 C

Footling

 D

Knee

Ans. A

Explanation:

Umbilical cord compression and prolapse may be associated with breech delivery, particularly in complete (5%) and footling (15%) presentations. 

  • This is due to the inability of the presenting part to fill the maternal pelvis, either because of prematurity or poor application of the presenting part to the cervix so that the umbilical cord is allowed to prolapse below the level of the breech. 
  • Frank breech presentation offers a contoured presenting part, which is better accommodated to the maternal pelvis and is usually well applied to the cervix. 
  • The incidence of cord prolapse in frank breech is only 0.5% (the same as for cephalic presentations).
 
Ref: Kish K., Collea J.V. (2007). Chapter 21. Malpresentation & Cord Prolapse. In A.H. DeCherney, L. Nathan (Eds), CURRENT Diagnosis & Treatment Obstetrics & Gynecology, 10e.

Q. 2

Cord prolapse is most commonly associated with:

 A

Transverse lie

 B

Breech

 C

Contracted pelvis

 D

Prematurity

Q. 2

Cord prolapse is most commonly associated with:

 A

Transverse lie

 B

Breech

 C

Contracted pelvis

 D

Prematurity

Ans. A

Explanation:

Transverse lie


Q. 3

Best treatment of Cord prolapse is :

 A

Replace the cord in vagina

 B

Cesarean section

 C

Immediate vaginal delivery

 D

None of the above

Q. 3

Best treatment of Cord prolapse is :

 A

Replace the cord in vagina

 B

Cesarean section

 C

Immediate vaginal delivery

 D

None of the above

Ans. B

Explanation:

Cesarean section


Q. 4

The chief cause of perinatal mortality in the type of fetal life shown in the photograph below is ? 

 A

Intracranial hemorrhage.

 B

Prolapse of umbilical cord.

 C

Delay in delivery of head.

 D

Abnormalities.

Q. 4

The chief cause of perinatal mortality in the type of fetal life shown in the photograph below is ? 

 A

Intracranial hemorrhage.

 B

Prolapse of umbilical cord.

 C

Delay in delivery of head.

 D

Abnormalities.

Ans. A

Explanation:

The fetal life type as shown in the picture above represents Frank breech. In this position, the baby’s buttocks are aimed at the birth canal with its legs sticking straight up in front of his or her body and the feet near the head.

The chief cause of perinatal mortality in these cases are Intracranial hemorrhage.


Q. 5

Which of the following is not an etiology of cord  prolapse?

 A

Contracted pelvis

 B

Hydramnios

 C

Placenta previa

 D

Dextrarotated uterus

Q. 5

Which of the following is not an etiology of cord  prolapse?

 A

Contracted pelvis

 B

Hydramnios

 C

Placenta previa

 D

Dextrarotated uterus

Ans. D

Explanation:

Dextrarotated uterus is a normal physiological changed seen in pregnancy.

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




Malcare WordPress Security