Cord presentation and cord prolapse

Question 1

Cord presentation (cord compression)

Definition

Answer 1

Definition: umbilical cord lies between the presenting part and cervix with or without rupture of membranes.

Question 2

Cord presentation

• Causes
• Diagnosis

Answer 2

Causes
- Oligohydramnios
- Presentation abnormalities

Diagnosis

Fetal monitoring (CTG)

Question 3

Cord presentation

Management

Answer 3

1. Cord reduction (Trendelenburg position or knee-chest position)
2. Oxygenation
3. Amnioinfusion (until full cervical dilatation is achieved) – done by a catheter that penetrates the fetal membranes
4. Tocolysis in case of uterine tachysystoles
5. Vaginal delivery (dependent on clinical judgement and requires fully dilated and effaced cervix)or emergency C-section

Question 4

Cord prolapse

Definition

Answer 4

life-threatening emergency for the fetus, the umbilical cord descends through the cervix, with (or before) the presenting part of the fetus in the presence of ruptured of membranes

Question 5

Cord prolapse

Causes

Answer 5

Presentation abnormalities (breech, transverse lie)

Multiple pregnancies

Long umbilical cord

Polyhydramnios

Low weight fetus

ROM, AROM (because usually the head is higher which results in increased prolapse incidence)

Manual fetal maneuver

Question 6

Cord prolapse

Types

Answer 6

• Occult prolapse – umbilical cord descends alongside the presenting part but not beyond it
• Overt prolapse – umbilical cord descends past the presenting part and is lower than the presenting part in the pelvis

Question 7

Cord prolapse Dx

Answer 7

1. Vaginal examination

a. Intact membranes - digital palpation of pulsating cord

b. Ruptured membranes – digital palpation or it may be visual in the vulva

2. Sudden decelerations on CTG (especially after ROM

Question 8

Cord prolapse

Complications

Answer 8

Brain damage
Death

Question 9

Cord prolapse

Management

Answer 9

• C section
• Preparatory delivery measurements (on the way to operating room)

a. Fetus pushed back to uterus

b. Reposition of the mother to knee-chest or Trendelenburg positions

C. Filling the urinary bladder (using Foley catheter)

D. Tocolytics (terbutaline, fenoterol)

E. Digital displacement of the cord and covering it with wet pads – to avoid the cold air that might trigger cord spasms