Professional Documents
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Dr Sichone
Definitions
• There are three clinical types
• Cord presentation is the presence of one or more
loops of umbilical cord between the fetal presenting
part and the cervix without ruptured membranes.
• Occult Cord prolapse is descent of the umbilical cord
through the cervix alongside the presenting part in the
presence of ruptured membranes.
• Overt cord prolapse is the descent of the umbilical
cord past the presenting part in the presence of
ruptured membranes
Incidence and significance
• Incidence of cord prolapse ranges between 0.1
to 0.6%
• The significance of cord prolapse is to do with
the increased risk of birth asphyxia and
perinatal mortality as well as increased
operative deliveries
• Asphyxia may result in hypoxic-ischemic
encephalopathy and cerebral palsy
Principles of birth asphyxia
• Cord compression preventing venous return to
the fetus
• Umbilical cord spasms secondary to exposure
to the vaginal fluids and/or air
Risk factors
• Factors that prevents close application of the presenting part to the
lower part of the uterus and/or pelvic brim
– Polyhydramnios
– Unengaged presenting part
– Low lying placenta
– Multiparity
– Breech
– Second twin
– Malpresentation: transverse lie, oblique lie, unstable lie
– Prematurity <37 weeks
– Low birth weight
– Fetal congenital anomalies
– Contracted pelvis
Risk factors
• Cord abnormalities
– True knots
– Long cord
– Reduced content of wharton’s jelly and
• fetal hypoxia-acidosis may alter the turgidity
of the cord
Risk factors
• Manipulation of the fetus in the presence of
ruptured membranes
– External cephalic version
– Internal podalic version
– Stabilising induction of labour
– Applying fetal scalp electrode
– Insertion of uterine pressure transducer
– Artificial rupture of membranes
Diagnosis
• Occult prolapse—is difficult to diagnose. It should be suspected if
there is persistence of variable deceleration of fetal heart rate
pattern detected on CTG
• Cord presentation—The diagnosis is made by feeling the
pulsation of the cord through the intact membranes.
• Cord prolapse—The cord is palpated directly by the fingers and
its pulsation can be felt if the fetus is alive. Cord pulsation may
cease during uterine contraction which, however, returns after
the contraction passes off.
• Fetus may be alive even in the absence of cord pulsation. Prompt
USG for cardiac movements or auscultation for FHS to be done
before fetal death is declared
When should cord prolapse be suspected?