Module 3

Cord presentation
OBJECTIVES
 Definition
 Risk factors
 Prevention
 Diagnosis
 Principles
 Management
Definition
 Is an obstetric emergency where the umbilical cord passes
through cervix into the vagina in advance of the fetal
presenting part
 Prolapsed cord may be visible at the lower edge of
vagina(rare)
 Umbilical cord lies beside or just ahead of the fetal skull
 May be neither visible nor palpable
 Cord becomes trapped between fetal presenting part &
maternal bony pelvis
Cord prolapse image
Signs
 Abnormal findings on FHR
 Fetal hypoxia
 May present as severe, sudden deceleration
 Prolonged bradycardia
 Recurrent moderate-to-severe variable
deceleration
 NB: Malpresentation increase the risk of
cord prolapse during rupturing of
membranes
Risk factors
 AROM- presenting part not engaged
 Placement of a fetal scalp electrode or
intrauterine pressure catheter
 Amnioinfusion
 Attempted rotation of the fetal head
from OP to OA
 External cephalic version(ECV),
internal version or breech extraction
 Fetal malpresentation
Prevention measures
 Avoidance of an aminiotomy before
engagement
 Applying mild fundal pressure during
placement of fetal scalp electrode
 Advising mother to remain in bed after
AROM until prolapse & FHR
abnormalities can be excluded
Diagnosis
 Vaginal examination
Pulsating mass can be felt within or
extruding from vagina
 Fetal bradycardia (<120 bpm)
 Variable decelerations of FHR
PRINCIPLES
 Cord prolapse may result in fetal hypoxia
 Prompt delivery by caesarean section within
30 minutes, improve neonatal outcomes
 Vaginal delivery can be performed more
rapidly
 Reduce pressure on fetal presenting part
 Midwife’s gloved fingers are left in vagina
 Pushing presenting part upward to relieve
cord compression
Management of a prolapsed umbilical
cord
 Confirm gestational age & FHR with
fetoscope or doppler
 If fetus ia alive, perform a vaginal
examination to diagnose stage of labour
If fully dillated , immediately deliver
the baby by vacuum or forceps
If not fully dilated, call for C/S
emergency transfer to hospital
Management of a prolapsed umbilical
cord
 Call for help & inform mother of emergency
 Ask assistant to administer 4-6l per minute
via facemask & insert an IV line
 In first stage
Put on sterile gloves
Insert dominant hand into vagina
Place other hand on abdomen in supra pubic
region to keep presenting part out of pelvis
Management of a prolapsed umbilical
cord
Administer salbutamol 0.5 mg IV slowly
over 2 minutes to reduce contractions
Perform an immediate C/S
 IN SECOND STAGE OF LABOUR
Expedite delivery with episiotomy &
vacuum extraction or forceps
Prepare for resuscitation of newborn
Management of a prolapsed umbilical
cord
 If there is time delay in performing the
surgery;
Place two fingers or an entire hand into
vagina to elevate presenting part off cord
Place mother in knee-chest or steep
trendelenburg position
Consider bladder filling
Assistant monitors FHR to see if cord
compression is adequately relieved
Midwife maintains the position until fetus is
born via C/S
Management of a prolapsed
umbilical cord
 If cord prolapse is present
Replace the cord gently into vagina vault
using wet gauze to prevent vasospasm
Moist tampon or 4x4 gauze can be inserted
gently into vagina below cord to help hold it
in place
If cord compression is relieved, place
woman in left lateral(Sims) position, with a
pillow under hips
Management of a prolapsed umbilical
cord
 During transfer, in delivery unit or
operating room
Verify FHR and obtain a tracing
C/S is not indicated if fetus is deceased
 Recording and interpretation
Document and date all activities
Document all resuscitation efforts
Management of a prolapsed
umbilical cord
Store cardiotocograph (CTG) tracings
in a safe place
Write an incident report