cord presentation

Question 1

What is the difference between cord presentation & cord prolapse?

Answer 1

Cord presentation -> descent of cord below presenting fetal part while fetal membranes are intact

Cord prolapse -> descent below presenting fetal part while membranes are ruptured

Question 2

What are the complications of cord prolapse?

Answer 2

1- Cord compression by presenting fetal part + vasospasm due to exposure of vaginal fluid & air
2- ischemia -> hypoxia (respiratory acidosis)
3- asphyxia (metabolic acidosis)
4- mortality 27%

Question 3

What are the causes of cord prolapse?

Answer 3

1- malposition & malpresentation
2- if head is too high
3- excessive OB manipulations (ECV)
4- after AROM before head engagement
5- induction of labour by cervical balloon
6- CFMF
7- long cord (>80cm)
8- abnormal placentation
9- grand-multipara
10- polyhydramnios

Question 4

How is cord prolapse diagnosed clinically?

Answer 4

1- pulsation can be felt through the intact membrane
2- when head is pushed down -> fetal heart rate will slow down
3- when membranes rupture -> fetal distress

Question 5

How can we exclude cord prolapse immediately after rupture of membranes?

Answer 5

Every woman should be examined vaginally
- in cord prolapse -> loop of cord may be seen by speculum or felt in the vagina or present at vulva

Question 6

What are the first steps that should be taken in cord prolapse?

Answer 6

With suspicious of pathological CTG
1- stop IV oxytocin
2- O2 face mask
3- left lateral position
4- IV fluid to correct hypovolemia
5- consider tocolysis (terbutaline/salbutamol)
6- elevate the presenting part off the cord
7- patient placed in Trendelenburg or knee-chest position
8- Foley’s catheter instillation of 500-750ml NS inside the bladder to push fetus away
9- instruct mother not to push down
10- manual replacement of the cord into uterus OR place it back inside the vagina OR cover it with a pad soaked in warm saline
11- continuous fetal monitoring

Question 7

How is cord prolapse managed?

Answer 7

1- if cervix is not fully dilated -> C section within 30 minutes
2- if cervix is fully dilated & cephalic presentation & head is engaged-> immediate forceps or VE
3- if cervix is fully dilated but not engaged or breech -> C section
4- any malpresentation -> C section
5- if baby is dead -> labour is left until vaginal delivery