Cord Prolapse

Question 1

RISK FACTORS:

Answer 1

1. Breech presentation
2. Preterm labour/Prematurity
3. Abnormal lie
4. Twin pregnancy
5. Polyhydraminos
6. Amniotomy
7. Multiparity
8. Cephalopelvic disproportion
9. Placenta praevia
10. Long umbilical cord
11. High fetal station

Question 2

MANAGEMENT:

Answer 2

1. Tocolytics ie terbutaline 0.25 mg if persistent CTG abnormality and prevent presenting part from compressing cord.
2. Keep cord warm and moist and don’t push back inside if it is pass the introitus. Avoid handling cord to prevent vasospasm
3. Get patient on all fours
4. Immediate C-section or instrumental delivery if cervix fully dilated and head low

Question 3

EPIDEMIOLOGY:

Answer 3

• 1 in 500 pregnancies

- Most frequently occurs during artificial rupture of membranes

Question 4

COMPLICATIONS:

Answer 4

Compression of cord/cord spasm leading to fetal hypoxia and eventually irreversible damage/death

Question 5

DIAGNOSIS:

Answer 5

Abnormal fetal heart rate + cord palpable vaginally OR cord visible beyond level of introitus

Question 6

TYPES:

1. Overt cord prolapse
2. Occult cord prolapse
3. Funic presentation

Answer 6

1. • Cord slips past and presents at cervix/descends further into vagina
     - Most common in premature babies and AROM
2. • Cord descends alongside presenting part
     - Can occur in intact/ruptured membrane
3. • Membrane has not ruptured but cord can be felt during vaginal examination
     - Can present as overt/occult cord prolapse post rupture of membrane

Question 7

MANAGEMENT(OCCULT PROLAPSE):

Answer 7

1. Left lateral position(exaggerated Sim’s position)
2. Monitor CTG and fetal heart rate
3. If persistently abnormal, C-section
4. If back to normal, allow labour with monitoring