Cord Prolapse and Shoulder Dystocia

Question 1

What is cord prolapse?

Answer 1

Descent of the cord through the cervix below the presenting part after rupture of membranes.
This is an obstetric emergency as compression of the cord and vasospasm due to exposure causes foetal asphyxia

Question 2

What are the foetal risk factors for cord prolapse?

Answer 2

Footling breech presentation
Prematurity
Unengaged head 
Polyhydramnios
Transverse/unstable lie
2nd twin 
Male

Question 3

What should you do in the situation of a cord prolapse?

Answer 3

Get senior help and activate alarms
Keep cord in vagina
Deliver the baby as quickly as possible either through C section or instrumental delivery if the cervix is fully dilated
Displace presenting part to stop it compressing the cord
Tocolysis e.g. terbutaline
Paired cord blood samples taken for pH and base excess to exclude intrapartum hypoxic brain injury

Question 4

What is the RCOG definition of shoulder dystocia?

Answer 4

A delivery requiring additional obstetric manoeuvres to release the shoulders after gentle downward tract has failed.

Question 5

What are the complications of shoulder dystocia?

Answer 5

Postpartum haemorrhage
4th degree perineal tears
Brachial plexus injury to the baby

Question 6

What are the associations of shoulder dystocia?

Answer 6

LGA/postmaturity
Diabetes
Maternal BMI over 30
Previous shoulder dystocia
Induced/assisted/oxytocin augmented deliveries

Question 7

What are the different management strategies for shoulder dystocia?

Answer 7

Episiotomy to give space for internal manoeuvres
Place in McRoberts position
Suprapubic pressure
Enter the pelvis for internal manoeuvres to rotate the baby
Get mother on all fours
Other manoeuvres
Check baby for clavicle fracture, erbs palsy
Record timing and sequence of manoeuvres