10/11) Labour & Delivery - Umbilical cord prolapse

Question 1

Incidence of cord prolapse

Answer 1

0.3%

Question 2

Incidence of cord prolapse in breech presentation

Answer 2

1%

Question 3

Incidence of cord presentation in breech

Answer 3

4%

Question 4

Perinatal mortality associated with cord prolapse

Answer 4

91 in 1000

Question 5

Increase in perinatal mortality if cord prolapse occurs outside of hospital

Answer 5

10 x increased

Question 6

What percentage of cord prolapses are preceded by a procedure?

Answer 6

50%

Question 7

Procedures which can precede a cord prolapse

Answer 7

ARM with high head
ECV, internal podalic version
Balloon catheter induction 
Stabilising presenting art
Manual rotation
Intrauterine pressure transducer

Question 8

Risk factors for cord prolapse

Answer 8

Multiparity
Low placenta
Low EFW
Prematurity
Poly hydra bios
Congenital anomalies
Breech/transverse/oblique/unstable
Unengaged presenting part
Second twin

Question 9

FHR abnormalities associated with cord prolapse

Answer 9

66% variable decelerations

34% bradycardia

Question 10

When to admit transverse/oblique/unstable lie?

Answer 10

37 weeks

Question 11

How much to fill bladder if using bladder to elevate head?

Answer 11

500-750mL

Question 12

Position if at home with cord prolapse

Answer 12

Knee chest whilst awaiting ambulance. Exaggerated Sims during transfer.

Question 13

Delivery for cord prolapse

Answer 13

CS if delivery not imminent - Cat 1 if FHR abnormalities, can consider Cat 2 if no FHR concerns. Regional anaesthesia can be considered for experienced anaesthetist.
Vaginal birth if likely to be quick and successful.