Cord Prolapse

Question 1

Define cold prolapse

Answer 1

Umbilical cord prolapses below the presenting part after rupture of the membranes.

Question 2

What are the risk factors for cord prolapse

Answer 2

Breech presentation, especially footling
Abnormal lie: Transverse, oblique
Polyhydramnios
Multiple pregnancies
Prematurity
High head or unengaged presenting part
Unusually long umbilical cord
Procedural: ARM | ECV | balloon catheter induction | stabilising induction of labour

Question 3

What is the risk of cord prolapse

Answer 3

Cord may be compressed by the presenting baby, or may undergo vasospasm due to exposure to the temperature of the environment
Both would lead to compromise of the foetal circulation and if the foetus is not delivered, it may lead to neurological damage or death

Question 4

What are the signs of cord prolapse on examination

Answer 4

Pelvic: Cord felt/seen protruding from the vagina

(CTG: signs of foetal distress)

Question 5

What is the management for cord prolapse

Answer 5

1. Press the emergency buzzer/alert alarm and announce a cord prolapse
2. Relieve pressure on the cord
3. Prepare for immediate birth - Cat 1 C/S
   
   • Call experienced Obstetric and midwifery staff, maternity theatre team, neonatologist
   • Secure transfer to labour ward
   • Assess FHR to determine urgency → FHR normal → cat 2
   • full dilation → can attempt vaginal birth
4. Secure IV access and take bloods
5. Continuously monitor foetal heart rate with CTG

Question 6

What is the method for relieving the pressure off the cord

Answer 6

Manually elevate the presenting part
Position women in either:
- Exaggerated Sims position - move woman into left-lateral position with head down and pillow placed under left hip
- Knee-chest position
- Consider bladder filling if there will be a delay in delivery, apply a DRY pad to keep cord inside the vagina
Consider tocolysis with SC terbutaline 0.25mg while preparing for delivery if there are persistent FHR abnormalities after attempts to prevent compression mechanically

Question 7

What should be done post-natally after cord prolapse

Answer 7

Paired umbilical cord gases for pH and BE measurement
Documentation (Pro forma) and clinical risk incident report/datex
Debrief mother and relatives

Question 8

How common is cord prolapse

Answer 8

1 in 200 - 1 in 1000 births

Question 9

What is the mortality of cord prolapse

Answer 9

Perinatal mortality 91 per 1000 (About 9.1% chance of miscarriage/stillbirth)