Cord Prolapse

Question 1

Risks with cord prolapse

Answer 1

Hypoxia and can progress to:
SB
Neonatal encephalopathy
CP

Question 2

Management

Answer 2

Knee-to-chest face down position
Wrap cord in wet packs if at introitus to prevent vasoconstriction
Manual elevation of presenting part vaginally
Continued to assess FHR
Tocolysis (if abnormal trace or time for reg anaesthesia)
Fill the bladder to lift presenting part and inhibit contractions

Expectant management with extreme prematurity
Manipulating the cord can lead to vasoconstriction and be counterproductive

**can do assisted delivery if feasible and imminent (9Cm+ and multiparous)

Question 3

Risk factors for cord prolapse

Answer 3

Transverse or unstable lie
Breech (particularly footling (20%)
Multiple pregnancy (2nd twin!)
Prematurity/ LBW
Obstetric interventions (ARM, ECV, IOL)
CPD
Multiparous
Polyhydramnios
Abnormal placentation (LLP)

Question 4

Tocolysis

Answer 4

250 mcg SC or 250mcg IV over 5 min of terbutaline

Salbutamol 100mcg inhaled (1-2 puffs 100mcg dose) or 100mcg IV over 1 min.

Question 5

CTG in cord prolapse

Answer 5

Prolonged fetal Brady OR
Variable decels (complicated) in a previously normal trace