Cord prolapse

Question 1

When to suspect cord prolapse

Answer 1

1. May not have any overt signs or fetal distress
2. If ROM->examine, abnormal CTG
3. Examine for cord prolapse at every presentation, after SROM, risk factors, CTG abnormal

Question 2

Risk factors

Answer 2

1. General
Fetal anomalies
Second twin
Multiparity
Low BW
Prematurity
Breech.transverse/oblique/unstable lie
Low lying placenta
Unengaged presenting part
2. Procedure related
Internal podalic version
External cephalic version
ARM
Vaginal manipulation of fetus w/ ruptured membrane

Question 3

Is USS useful

Answer 3

Not specific/sensitive enough to exclude

Question 4

Prevention

Answer 4

1. Transverse/oblique/unstable
   Elective admission after 37 + 6
   Advise to present quickly if signs of labour or suspicion for ROM
2. If presenting part mobile, station high->Avoid ARM

Question 5

Management

Answer 5

1. Recognise non reassuring trace
2. Assistance called
3. Prep for immediate delivery->alert obs/gynae, anaesthetics, NICU
4. Visualise/palpate the cord
5. Minimal cord handling
6. Assess fetal status->CTG, USS
7. Assess labour progress
8. Do not attempt replacement
9. IV access, IVF, bloods->FBC, UEC, GH Xmatch, catheter, analgesia
10. Elevate presenting part
    Fill bladder
    Knee to chest
    Trendelenberg
11. Tocolysis considered if waiting c section and ongoing fetal HR abnormalities/decompression failed/delayed delivery
12. If full dilitation and anticipate quick and safe delivery->vagina
13. Otherwise cesaerean
14. Anticipate resuscitation
15. Take cord blood: pH, base excess