Cord Prolapse

Question 1

Define cord prolapse and its types

Answer 1

Umbilical cord descends through the cervix, with (or before) the presenting part of the fetus

Occult (incomplete) = cord descends alongside the presenting part, but not beyond it

Overt (complete) = cord descends past the presenting part and is lower than the presenting part in the pelvis

Cord presentation = the presence of the umbilical cord between the presenting part and the cervix. This can occur with or without intact membranes.

Question 2

Why does hypoxia occur secondary to cord prolapse?

Answer 2

Occlusion = the presenting part of the fetus presses onto the umbilical cord, occluding blood flow to the fetus

Arterial vasospasm = the exposure of the umbilical cord to the cold atmosphere results in umbilical arterial vasospasm, reducing blood flow to the fetus

Question 3

What are the main risk factors for cord prolapse?

Answer 3

Breech presentation = in a footling breech, the cord can easily slip between and past the fetal feet and into the pelvis

Unstable lie = this is where the presentation of the fetus changes between transverse/oblique/breech and back

Artificial rupture of membranes = particularly when the presenting part of the fetus is high in the pelvis

Polyhydramnios = excessive amniotic fluid around the fetus

Prematurity

Question 4

What are the clinical features of an UCP?

Answer 4

Fetal HR problem - bradycardia

Absent membranes

Question 5

How should UCP be managed?

Answer 5

Avoid handling cord - reduce vasospasm

Manually elevate the presenting part

L lateral position

Tocolysis (terbutaline) - relaxes the uterus to stop contractions

Delivery via CS