Cord Prolapse / Presentation

Question 1

Define cord prolapse

Answer 1

Where the umbilical cord is visible / protruding from the vagina or is palpable on vaginal examination

Question 2

Name some risk factors / causes of cord prolapse

Answer 2

Polyhydramnious
Breech presentation
Multiple pregnancy
Multiparity / grandmultiparity
Fetal congential abnormalities
Unstable lie
ECV
ARM

Question 3

What is the current debate regarding the touching of the cord in a prolapse?

Answer 3

If you do touch - can cause vaso spasm

If you don’t touch the cord - the cold air could cause it to vaso spam

Question 4

What is the incidence of cord prolapse

Answer 4

0.1%-0.6% of all births (PROMPT, 2016)

Question 5

Name the 3 D’s post procedure

Answer 5

Datix
Documentation
Debrief

Question 6

What should immediately be done when a cord prolapse is found in the community / delivery suite situation?

Answer 6

Escalate!!
D/S: emergency buzzer “2222” call - state cord prolapse.
Community: “999” Time critical paramedic ambulance - state cord prolapse.

Question 7

What is the management after escalating a cord prolapse?

Answer 7

Manually alleviate pressure on presenting part
Exaggerated sims position
Knee to chest position (all fours)
Consider filling the bladder - empty bladder first, fill with sterile water (500-700mls)
Prompt (2016) - apply dry pad to keep cord inside the vagina
Stop syntocinon infusion
Secure IV acess - take bloods (x match, group and save, clotting, FBC, LFTs and U’s and E’s

Question 8

What is the exaggerated sims position?

Answer 8

Move woman to left lateral with head down and pillow placed under the hip

Question 9

How should you deliver a baby with a cord prolapse?

Answer 9

Vaginally is birth is imminent

C Section if not imminent