Intrapartum Care - Cord Prolapse

Question 1

What is Cord Prolapse?

Answer 1

The umbilical cord descends below the presenting part of the foetus and through the cervix into the vagina, after the rupture of the foetal membranes.

Question 2

Main Risk Factor of Cord Prolapse.

Answer 2

Abnormal Lie (after Week 37 - Unstable, Transverse, Oblique) because it provides space for the cord to prolapse below.

Question 3

Main Danger of Cord Prolapse.

Answer 3

Foetal Hypoxia - compression of the cord.

Question 4

Other Risk Factors of Cord Prolapse.

Answer 4

1. Prematurity.
2. Multiparty.
3. Polyhydramnios.
4. Twin Pregnancy.
5. Cephalopelvic Disproportion.
6. Abnormal Presentations.

Question 5

Investigations of Cord Prolapse (3).

Answer 5

1. Suspect if foetal distress on CTG.
2. Vaginal Examination : Prolapsed Umbilical Cord.
3. Speculum Examination.

Question 6

Management of Cord Prolapse.

Answer 6

1. Emergency C-Section.
2. Do Not Push Back Cord.
3. Keep Cord Warm and Wet with Minimal Handling (Risk : Vasospasm) if past level of Introitus.
4. Push Presenting Part of Baby Upwards if Compression.
5. Repositioning.
6. Tocolysis.
7. Retrofilling Bladder with 500-700ml Saline.

Question 7

What positions are recommended in Cord Prolapse?

Answer 7

Left lateral position with a pillow under the hip or knee-chest position (all 4s) to use gravity to draw the foetus away from the pelvis and reduce compression.

Question 8

Why is Tocolysis a possible option?

Answer 8

Minimise contractions whilst waiting delivery by C-Section.