Cord Prolapse

Question 1

What is the benefit of early hospital notification in cord prolapse?

Answer 1

Allows early surgical preparation for a potential emergency caesarean.

Question 2

In what circumstances of a cord prolapse should the mother be encouraged to push? What should paramedics prepare for?

Answer 2

If presenting part is distending the perineum and the mother is pushing uncontrollably.
Prepare for newborn resus.

Question 3

Why should cord handling be kept to a minimum in a cord prolapse?

Answer 3

can lead to vasospasm or contraction of umbilical vessels.

Question 4

What are key elements of history taking in a cord-prolapse patient?

Answer 4

1. Time of ROM
2. How long cord has been visible
3. Due date
4. Fetal movement felt
5. Onset of labour
6. Cxns present
7. Fetal presentation if known
8. PV bleeding

Question 5

In a cord prolapse where the birth is not imminent, what is the management?

Answer 5

1. Position pt semi-prone with hips elevated over towels and reassure/explain to pt
2. High flow O2 therapy
3. Minimise cord handling, keep cord warm and moist. Use 2 fingers to gently place cord in vagina.
   - If unsuccessful, cover with warm saline packs.
4. If presenting part pressing on cord, insert fingers into vagina and push head away from cord - maintain this pressure until birth commences or advised to release

Question 6

In a cord prolapse where birth is not imminent but the presenting part is visibly applying pressure to the cord, what is the Mx?

Answer 6

If pressing on cord, insert fingers into vagina and push the presenting part away from the cord. Maintain pressure until birth commences.