Umbilical cord prolapse

Question 1

What is umbilical cord prolapse?

Answer 1

• when the umbilical cord descends belowe the presenting part of the fetus and through the cervix into the vagina, after rupture of fetal membranes
• danger of cord compression by presenting part resulting in fetal hypoxia

Question 2

What is the most significant risk factor for cord prolapse?

Answer 2

• abnormal lie after 37 weeks (unstable, transverse or oblique)
• as being in abnormal lie provides space for the cord to prolapse below the presenting part
• in a cephalic lie the head typically descends into pelvis so no room for cord to descend

Question 3

How is cord prolapse diagnosed?

Answer 3

• should be suspected when there are signs of fetal distress on the CTG
• can then be diagnosed by speculum examination

Question 4

How is cord prolapse managed?

Answer 4

• emergency c-section as normal vaginal delivery has high risk of cord compression and thus hypoxia
• pushing cord back in is not reccomended
• cord should be kept warm and wet and have minimal handling whilst waiting for delivery (handling causes vasospasm)
• Tocolytic medication (e.g. terbutaline) can be used to minimise contractions whilst waiting for delivery by caesarean section.