Cord prolapse

Presented By
Samia Abu Aishia
 Definitions
Presentation of the cord
occurs when a loop
of cord lies below
the presenting part
of the fetus, the
membranes being
intact.
 a. Occult cord
presentation -
occurs when the cord
descends alongside,
but not past, the
presenting part. It
can occur with intact
or ruptured
membranes
 Overt prolapse (cord
prolapse) – where the
umbilical cord lies in
front of or beside the
presenting part in the
presence of rupture
membrane. It may
descend into the
vagina. It may pass
thorough the introitus
and out the vagina.
 Risk factor
Fetal
abnormal presentation : the highest incidence is in the
following order
◦ transverse lie
◦ Breech presentation, especially the footling.
◦ Cephalic presentation.
Prematurity: two factor play part in the failure to fill
the inlet:
◦ The smallness of presenting part.
◦ The frequency of abnormal position in premature
labours.
Multiple pregnancies: The factors involved here
include:
◦ Greater frequency of abnormal presentation.
◦ High incidence of polyhydramnios
◦ Rupture of the membrane of second twin while
Macrosomia
Polyhydramnios: when the membrane rupture,
the large amount of fluid out and the cord may be
washed down.
Maternal and obstetric
 Multiparty.
 Cephalopelvic disproportion
 Pelvic tumors.
 Artificial rupture of the membrane when
high head.
 version and extraction
 Cord and placenta

• Long cord.
• low lying placenta
 Diagnosis of prolapse cord
The diagnosis of prolapse cord is made by
following way:
Seeing the cord outside the vulva.
Feeling the cord on the vaginal examination,
since the fetal mortality is high once the cord
has protruded the introitus.
CTG abnormality (bradycardia, sever variable
deceleration
 Vaginal examination should be made:

 When there is unexplained fetal distress, and

especially if the presenting part is not well
engaged.
 When the membranes rupture with a high
presenting part.
 In all cases of malpresentation when the
membrane rupture.
 When the baby is markedly premature.
 In twins cases.
 Management of prolapse cord at home
The midwife should call the paramedic ambulance
service .
She must attempt to relive pressure on the cord by
moving the woman into the Knee-chest position or
the exaggerated Sims position.
The foot of the bed is elevated if possible.
The midwife should introduce two fingers into the
vagina and push up the presenting part during
contractions to further relieve cord compression.
Management of prolapse cord at
home….
Ifthe cord is protruding from the valva, the
midwife may attempt to replace it gently within
the vagina in order to prevent chilling and spasm
of the umbilical vessels.
Avoid excessive handling, and if the cord cannot
be replaced easily at the first attempt it may be
preferable to leave it alone.
The management will depend upon:

 The stage of labour.

 Whether the fetus alive or died.
 Management of prolapse cord in the
hospital
1. The cord prolapse is ignored and labour
allowed to proceed under the following
conditions:
◦ When the baby is dead.
◦ When the baby is known to be abnormal
e.g. anencephaly.
◦ When the fetus is so premature that is no
chance of survival.
2. measures to lesson cord compression and
improve the condition of the infant include:
◦ Place a hand in the vagina and pushes the
presenting part up and away from the cord.
◦ The patient is placed in the knee chest position or
trenedelenburg position, with the hips elevated
and the head low.
◦ The woman is given oxygen.
◦ The fetal heart is checked carefully and often.
◦ Vaginal examination is made to ascertain the
presentation, cervical dilatation, station of
presenting part, and condition of the cord..
3. The cervix is fully dilated:
◦ Cephalic presentation- instrumental delivery.
◦ Breech presentation: both feet should be brought
down and the baby extracted as a footling breech as
soon as possible.
◦ Transverse lie: internal podalic version to a
footling and extraction are done immediately.
4. The cervix is incompletely dilated: caesarian
section is the treatment of choice.
 Prevention
1. Identify risk factor or identify a cord
presentation on ultrasound.
2. Artificial rupture of membrane (ARM)
should not be done when the station is high.
3. if ARM is essential to manage a difficult
obstetric situation and the head is not
engaged and high
 Controlled ARM by the senior medical staff.
 Ensure emergency theater is available prior to
ARM.