Cord Prolapse Flashcards
What is cord prolapse?
Cord prolapse is a rare obstetric emergency where the umbilical cord descends through the cervix into the vagina ahead of the presenting part.
What are the typical symptoms of cord prolapse?
Symptoms may include visible or palpable umbilical cord in the vagina and changes in fetal heart rate, such as bradycardia or variable decelerations.
What are the types of cord prolapse?
Types include overt cord prolapse (cord visible or palpable outside the cervix) and occult cord prolapse (cord trapped alongside the presenting part).
What is the prevalence of cord prolapse?
Cord prolapse occurs in about 0.1-0.6% of deliveries, making it a rare obstetric emergency.
What are the risk factors for cord prolapse?
Risk factors include malpresentation, polyhydramnios, multiple pregnancy, preterm labour, and artificial rupture of membranes.
What is the pathophysiology of cord prolapse?
It involves the umbilical cord descending below the presenting part, leading to compression or vasospasm and subsequent fetal hypoxia.
What are the potential complications of cord prolapse?
Complications include fetal hypoxia, acidosis, stillbirth, and the need for emergency delivery.
How is cord prolapse typically diagnosed?
Diagnosis is made through clinical examination, identifying a visible or palpable cord and fetal heart rate abnormalities.
What are the clinical examination findings in cord prolapse?
Findings include visible or palpable umbilical cord in the vagina or outside the introitus, and signs of fetal distress on monitoring.
What is the initial management of cord prolapse?
Initial management includes calling for immediate help, relieving cord compression, and positioning the mother to reduce pressure on the cord.
What positions can be used to relieve cord compression?
Positions include the knee-chest position, exaggerated Sims position, or Trendelenburg position.
What medical interventions are used for cord prolapse?
Interventions include manually elevating the presenting part off the cord and administering tocolytics to reduce uterine contractions.
What is the definitive management of cord prolapse?
Definitive management involves expedited delivery, usually via emergency caesarean section, to minimise fetal hypoxia.
How is fetal monitoring performed in cord prolapse?
Continuous fetal heart rate monitoring is essential to assess for signs of hypoxia or acidosis.
What role does tocolysis play in managing cord prolapse?
Tocolysis (e.g., with terbutaline) can reduce uterine contractions and alleviate cord compression while preparing for delivery.
What is the prognosis for cord prolapse?
Prognosis depends on the time to delivery, with prompt intervention associated with good neonatal outcomes in many cases.
What is the differential diagnosis for cord prolapse?
Differential diagnoses include cord presentation (cord below the presenting part but membranes intact) and other causes of fetal distress.
What are the common signs of fetal distress in cord prolapse?
Signs include fetal bradycardia, recurrent decelerations, and abnormal cardiotocography (CTG) patterns.
What should be avoided during the management of cord prolapse?
Vaginal examinations should be minimised to reduce the risk of cord vasospasm or trauma.
What factors influence the choice of delivery method in cord prolapse?
Factors include gestational age, fetal condition, and the stage of labour.
What are the maternal risks associated with cord prolapse?
Maternal risks are generally low but may include surgical risks associated with emergency caesarean section.
What preventive measures can reduce the risk of cord prolapse?
Preventive measures include careful monitoring during labour, especially in high-risk cases, and avoiding artificial rupture of membranes unless necessary.
How can cord prolapse impact future pregnancies?
Women with a history of cord prolapse are generally at low risk for recurrence, but careful monitoring is recommended in subsequent pregnancies.
What psychological support might be needed after cord prolapse?
Women may need counselling and emotional support due to the distress and potential complications associated with the emergency.
