Cord Prolapse

Question 1

What is a cord prolapse?

Answer 1

Involves the cord descending through the cervix ahead of the the presenting part of the fetus, after the rupture of membranes

Question 2

Why is it an emergency?

Answer 2

Cord compression and vasospasm from exposure of the cord causes fetal asphyxia

Question 3

In how many deliveries does it occur?

Answer 3

1/500

Question 4

What risk factors are there?

Answer 4

Prematurity
Twin pregnancy
Polyhydraminos 
Cephalopelvic disproportion
Abnormal presentations - breech, transverse 
Placenta praevia
Long umbilical cord 
High fetal station

Question 5

The majority of cord prolapses occur at…

Answer 5

Artificial rupture of membranes

Question 6

Whenever you rupture the membranes, remember that cord prolapse is possible, especially if…

Answer 6

The presenting part is poorly applied

Question 7

If cord presentation is noted prior to membrane rupture, what should be done?

Answer 7

C section

Question 8

How is it diagnosed?

Answer 8

Cord is visible at introitus and palpable vaginally

Fetal bradycardia or variable fetal heart decelerations

Question 9

How is it managed?

Answer 9

Stop presenting part occluding the cord, the presenting part should be elevated either manually or by filling the bladder
If the cord is past the level of the introitus, it should be kept warm and moist but not pushed back inside
Tocolytics (terbutaline) to reduce contractions and helps bradycardia, can be considered while preparing for CS

If cervix fully dilated and presenting part low: delivery by forceps/ventouse or breech extraction
If not: C section - patient asked to go on all fours in meantime