Obstetric emergencies including cord prolapse

Question 1

What % of pregnancies does cord prolapse occur in?

Answer 1

0.1-0.6%

Question 2

What % of breech presentations does cord prolapse occur in?

Answer 2

1%

Question 3

What is the perinatal mortality rate associated with cord prolapse?

Answer 3

91 per 1000

Question 4

What are the risk factors for cord prolapse?

Answer 4

General:

• Low birthweight <2.5 kg
• Multiparity
• Fetal congenital anomalies
• Second twin
• Low lying placenta
• Preterm labour
• Breech presentation
• Tranverse, oblique or unstable lie
• Polyhydramnios
• Unengaged presenting part

Procedure-based:

• During ECV
• Internal podalic version
• Vaginal manipulation of fetus with ruptured membranes
• ARM with high presenting part
• Stabilising IOL
• Large balloon catheter IOL (>180 mL)
• Insertion of intrauterine pressure transducer

Question 5

List the ways of preventing cord prolapse:

Answer 5

• Selective ultrasound screening: breech presentation at term, considering vaginal breech delivery.
• Elective hospital admission from 37+0 if transverse, oblique or unstable lie.
  
  • Advise women to present urgently if in labour or suspected SROM.
• Avoid ARM if high presenting part; if unavoidable need immediate recourse to Caesarean section available.
• Avoid upwards pressure on presenting part during VE and obstetric interventions.
• Cord presentation:
  
  • Avoid ARM if cord presentation felt.
  • If diagnosed in established labour, Caesarean section indicated.

Question 6

Outline your management of a cord prolapse in hospital:

Answer 6

• Consider cord prolapse
• Organise help
• Relieve pressure:
  
  • Manual elevation
  • Knees-chest or exaggerated Sims
  • Consider tocolysis
• Decision for birth:
  
  • Assess and assist birth by quickest means.
  • Urgency dependent on FHR and gestational age