Cord prolapse

Question 1

Define cord prolapse

Answer 1

A loop of umbilical cord is below the presenting part when membranes are ruptured

Question 2

What is the incidence of cord prolapse?

Answer 2

0.2%

Question 3

Does it affect more multips or primips?

Answer 3

multips

Question 4

What is the mortality rate and why?

Answer 4

25-50% - asphyxia

Question 5

What causes asphyxia?

Answer 5

• mechanical compression of cord between presenting part and bony pelvis
• spasm of cord vessels when exposed to cold or manipulated

Question 6

How do you diagnose cord prolapse?

Answer 6

VE - often preceded by fetal heart changes

Question 7

What do you do before managing cord prolapse?

Answer 7

ensure there is fetal heart via USS

Question 8

What are the antenatal risk factors for cord prolapse? 7

Answer 8

breech 
unstable lie 
oblique or transverse lie 
polyhydramnios 
ECV 
Expectant management of prom 
previous cord prolapse

Question 9

what are the Intrapartum risk factors for cord prolapse? 7

Answer 9

Amniotomy
prematurity
breech
internal podalic version (grap foot and pull) (second twin)
second twin
disimpaction of fetal head during rotational assisted delivery
fetal scalp electrode application

Question 10

How do you manage cord prolapse? 5

Answer 10

• Recognise, elevate, alleviate, deliver (READ)
• Aim - to reduce compression of the cord with minimal manipulation
• Traditionally delivery via lscs but if funic reduction successful consider ventouse
• consider +IV fluids, 02 via facial mask, discontinuing oxytocin
• if cord protruding out of introitus may need sterile gauze soaked in warm saline to moisten or replace into vagina

Question 11

How do you reduce the cord compression?

Answer 11

manual elevation of presenting part
tocolysis
bladder filling - saline in via catheter
knee-chest position, exagerated simms, trendelenburg
funic reduction

Question 12

What is funic reduction?

Answer 12

manual replacement of cord into uterus- gently pushed above presenting part
-rapid vaginal delivery