Cord prolapse

Question 1

Cord prolapse - def

Answer 1

Descent of umbilical cord alongside or beyond the presenting part in the presence of ruptured membranes
- Distinguish from cord presentation - less urgent condition in which the umbilical cord presents in front of the fetal presenting part with intact membranes

Question 2

Cord prolapse - path

Answer 2

• Compression of umbilical vessels by presenting part + vasospasm from cord exposure
• Fetal circulation compromised -> neurological sequelae/fetal death

Question 3

Cord prolapse - RF

Answer 3

1. Abnormal lie/presentation (transverse lie, breech)
2. Multiple pregnancy
3. Polyhydramnios
4. Prematurity
5. High head (i.e. presenting part is high or disengaged at start of labour)

Question 4

Cord prolapse - sx/presentation

Answer 4

1. Abrupt onset of severe, prolonged fetal bradycardia or moderate to severe variable decelerations in pt with previously normal tracing
2. Fetal HR changes soon after membrane rupture/obstetric intervention that dislodges the presenting part
3. Less common presentation = palpation of cord on VE (when ax progress of labour)
4. Less common presentation = pt feeling/seeing overt cord prolapse

Question 5

Cord prolapse - mx

Answer 5

1. Deliver fetus as rapidly as possible. May be by instrumental delivery or category 1 CS
2. Prevent further cord compression during transfer for CS by knee-to-chest position + retrofilling bladder with warm NS (elevates presenting part) if cannot perform CS immediately
3. Reduce cord into vagina and insert warm saline swab. Handle cord as little as possible (provokes further spasms)
4. Tocolytics (terbutaline) - abolish uterine contractions and improve oxygenation to fetus (use with CS)
5. Neonatal team must be present at delivery