Cord prolapse

Question 1

What is cord prolapse?

Answer 1

The descent of the umbilical cord through the cervix alongside (occult) or past (overt) the presenting part in the presence of ruptured membranes

Question 2

When is cord prolapse more likely to happen?

Answer 2

Towards the end of the pregnancy when the waters are more likely to break (past 37 weeks)

Question 3

What are the risk factors for cord prolapse?

Answer 3

Multiparity (5+ babies because uterus looses its tone)
Low lying placenta
Pelvic tumour
Low fibroid

Malpresentation
Breech
Unstable Lie
Unengaged Presenting Part
Multiple Pregnancy
Premature Labour
Polyhydramnios
IUGR /Low Birth Weight (LBW) <2500g
Foetal Congenital
Abnormalities

External Cephalic Version (ECV): physically moving the baby into position
Induction of Labour (IOL)
Artificial Rupture of Membranes (ARM)
Long cord

Question 4

What is the management of cord prolapse?

Answer 4

CORD:
- Consider in each vaginal examination
- Organise help from MDT
- Relieve pressure (manually, changing maternal posture, fill bladder, tocolysis, stop oxytocin infusion)
- Decision for birth (c-section, labour ward)

Question 5

What are the categories for a C-section?

Answer 5

Category 1: within 30 min, immediate threat to life
Category 2: within 1 hours. compromise that isn’t immediately life threatening
Category 3: no compromise but needs early delivery
Category 4: elective

Question 6

At what times are ultrasound scans offered during pregnancy?

Answer 6

At 12 weeks: for gestational age and genetic testing
At 20 weeks: for gendering and for more genetic tests

More often in complicated pregnancies