Cord prolapse Flashcards
What is cord prolapse?
Descent of the umbilical cord through the cervix alongside (occult) or past (overt) the presenting part in the presence of ruptured membranes
What is cord presentation?
The presence of the umbilical cord between the foetal presenting part and the cervix, with or without intact membranes
What does cord compression compromise?
Foetal blood supply
Describe the incidence of cord prolapse
0.2% of births
1% in breech presentation
At which gestation does cord prolapse often happen?
> 37weeks
List some risk factors for cord prolapse
Maternal
- Multiparity
- Low lying placenta
- Pelvic tumour
- Fibroids
Foetal
- Malpresentation
- Breech
- Unstable lie
- Presenting part
- Unengaged
- Multiple pregnancy
- Premature labour
- Polyhydramnios
- IUGR/LBW <2500g
- Foetal congenital abnormalities
Other
- ECV
- Stabilising induction of labour
- Artificial rupture of membranes
- Long cord
Describe the management of cord prolapse
Identify cord prolapse - confirm with vaginal examination but try not to handle cord as can cause spasm in baby
Call for help
Phone 2222 - obstetric and neonatal emergency
Make immediate preparations and transfer to theatre
Elevate presenting part with examining hand (pringle hand) - avoid handling the cord, support woman to move knee chest position or head down tilt in left lateral, assess cervix and FHR
Category 1 - LSCS if cord prolapse associated with abnormal FHR
Category 2 - LSCS if normal FHR
Category 3 - vaginal birth if gull dilated cervix and imminent swift birth
Prepare for neonatal resuscitation and communicate with parents
