Obstetrics (Cord prolapse)

Question 1

Is cord prolapse a time critical emergency?

Answer 1

• Yes - early diagnosis, immediate intervention and prompt transport to an appropriate facility are effective in reducing the perinatal mortality rate

Question 2

What is the preferred method of birth in a cord prolapse?

Answer 2

• C Section is preferred
• however if birth is imminent encourage mother to push - This ONLY applies when the presenting part is distending the perineum and the mother is pushing uncontrollably

Question 3

Can you handle the cord?

Answer 3

• cord handling should be kept at a minimum as this can lead to vasospasm or contraction of umbilical vessels

Question 4

What should you keep time of in a cord prolapse?

Answer 4

• time membranes ruptures
• how long the cord has been visable
• due date
• fetal movement felt
• onset of labour
• contractions present
• fetal presentation if known
• PV bleeding

Question 5

Recite the cord prolapse CPG

Answer 5

Question 6

How should you position the mother if birth is not imminent in a cord prolapse?

Answer 6

• position patient in semi-prone with hips elevated over folded towels
• provide explanation and reassurance
• high flow O2 therapy

Question 7

How do you manage the cord if birth is not imminent?

Answer 7

• minimise cord handling
• keep cord warm and moist
• use 2 fingers to gently place cord in vagina
• if unsuccessful cover with warm saline packs if possible

Question 8

If birth is not imminent, how do you manage the presenting part?

Answer 8

• if there is pressure on the cord by presenting part insert fingers to the vagina and push the presenting part (head) away from the cord
• maintain pressure until birth commences or advised to release

Question 9

what do you do if birth is commencing in a cord prolapse?

Answer 9

• instruct mother to push
• assist in delivery
• prepare for newborn resuscitation