Cord Prolapse

Question 1

What is cord prolaspe?

Answer 1

Cord prolapse involves the umbilical cord descending ahead of the presenting part of the foetus. Left untreated, this can lead to compression of the cord or cord spasm, which can cause foetal hypoxia and eventually irreversible damage or death.

Question 2

What are the different classifications of cord prolapse?

Answer 2

Occult (incomplete) – cord descends with presenting part but not beyond it
Overt (complete) – cord prolapses lower than the presenting part
Cord presentation – cord between the presenting part and the cervix

Question 3

Why is the mortality rate from cord prolaspe so high?

Answer 3

Mortality high because commonly occurs in preterm babies who are breech and with congenital defects.

Question 4

When do cord prolapses happen most often?

Answer 4

The majority of cord prolapses occur with rupture of the membranes.

Question 5

What are the risk factors for cord prolapse?

Answer 5

• Prematurity
• Multiple Pregnancy
• Polyhydramnios
• Cephalopelvic disproportion
• Abnormal presentations e.g. Breech, transverse lie and unstable lie
• ARM
• Placenta praevia
• Long umbilical cord
• High foetal station

Question 6

How does a cord prolapse usually present and what investigations should always follow this?

Answer 6

Cord prolapse should always be considered in the presence of non-reassuring foetal heart rate. Hence why VE and abdominal exam should always be done with a non-reassuring foetal CTG.

The diagnosis is usually made when the foetal heart rate becomes abnormal and the cord is palpable vaginally, or if the cord is visible beyond the level of the introitus.

Question 7

How should a cord prolapse be managed?

Answer 7

The presenting part of the foetus may be pushed back into the uterus to avoid compression.
Tocolytics should be used such as terbutaline or nifedipine
If the cord is past the level of the introitus, it should be kept warm and moist but should not be pushed back inside.
Patient adopts knees to chest position (on all 4s) with head on pillow until caesarean

Although this is the usual first-line method of delivery, an instrumental vaginal delivery is possible if the cervix is fully dilated and the head is low.