Mx - Cord Prolapse

Question 1

Cord prolapse is defined as

Answer 1

the descent of the umbilical cord alongside or past the presenting part in the presence of ruptured membranes

Question 2

The incidence of cord prolapse is 1/200, but risk factors are

Answer 2

BREECH presentation
preterm labour
multiple pregnancies
grand multiparity
polyhydramnios

Question 3

How should I manage a call to cord prolapse?

Answer 3

1) Call for help - obstetrics, senior midwifery, anaesthetics, paediatrics and OT staff
2) Give oxygen
3) Elevation of the presenting part
- manually (remove hand only as baby is delivered)
- steep Trendelenberg position (left lateral ideal)
- fill the bladder with Foley’s catheter
4) Place warm, wet cloth over cord and avoid handling it to prevent vasospasm
5) Immediate delivery is indicated - if vaginal delivery is not imminent the patient should be transferred to OT for Em CS.
6) Senior neonatal resuscitation team should be in attendence