Cord Prolapse

Question 1

Which of the following accurately defines a cord prolapse?

1 - cord is wrapped around babies neck
2 - cord descends ahead of the presenting part of the foetus
3 - cord initiates early labour
4 - can include all of the above

Answer 1

2 - cord descends ahead of the presenting part of the foetus

Question 2

How common is cord prolapse?

1 - 1:50
2 - 1:500
3 - 1:1500
4 - 1:5000

Answer 2

3 - 1:1500

Question 3

If the cord is prolapsed this can lead to what?

1 - cord compression
2 - cord spasm
3 - foetal hypoxia
4 - foetal death
5 - all of the above

Answer 3

5 - all of the above

Question 4

Which of the following is NOT typically a risk factor for cord prolapse?

1 - previous pregnancy
2 - prematurity
3 - multiparity
4 - polyhydramnios
5 - twin pregnancy
6 - cephalopelvic disproportion
7 - abnormal presentations e.g. Breech, transverse lie

Answer 4

1 - previous pregnancy

Question 5

All of the following can cause cord prolapse, but which of the following accounts for up to 50% of cord prolapse?

1 - artificial rupture of membranes
2 - external cephalic version
3 - placement of a cervical ripening balloon
4 - intrauterine pressure catheter

Answer 5

1 - artificial rupture of membranes

Question 6

Which of the following is NOT typically used to diagnose cord prolapse?

1 -abnormal foetal heart rate
2 - transvaginal ultrasound
3 - palpable cord vaginally
4 - cord is visible beyond the level of the introitus (external opening of vagina)

Answer 6

2 - transvaginal ultrasound

Question 7

Is cord prolapse dangerous?

Answer 7

• yes
• medical emergency

Question 8

If the the presenting part of the foetus of can be seen behind the cord, which of the following can be tried?

1 - clamp cord and deliver the baby
2 - switch to a c-section straight away
3 - push foetus back into uterus to avoid cord compression
4 - continue to delivery baby vaginally using tools

Answer 8

3 - push foetus back into uterus to avoid cord compression

• if the cord reaches the introitus, hands off approach but keep warm and moist to avoid vasospasms

Question 9

If the the presenting part of the foetus of can be seen behind the cord, what position should the patient be advised to go into whilst awaiting an immediate c-section?

1 - all fours
2 - lithotomy position
3 - on back
4 - lie on left side

Answer 9

1 - all fours

• left lateral position is an alternative if all 4s is not possible

Question 10

What medication may be used to slow the contractions?

1 - oxytocin
2 - epidural
3 - prostoglandins
4 - tocolytics

Answer 10

4 - tocolytics

Question 11

Can filling of the bladder help with cord prolapse?

Answer 11

• yes
• filled bladder elevates the presenting part

Question 12

Is a c-section always requires in cord prolapse?

Answer 12

• no
• typically 1st line
• BUT vaginal is possible if cervix is fully dilates and may need to use forceps