Umbilical cord Prolapse Flashcards
What is the incidence of cord prolapse?
0,1 - 0,6 %
What is the incidence of cord prolapse in breech presentation ?
> 1%
What is the perinatal mortality rate with cord prolapse?
91 / 1000
What is the definition of cord prolapse?
Descent of the umbilical cord through the cervix along side ( occult) or past the presentation part ( overt) in the presence of RUPTURED MEMBRANES
What is the definition of cord presentation?
Presence of the umbilical cord between the fetal presentation part & cervix with or without membrane rupture
What are the general risk factors for cord prolapse/ presentation?
1- multiparty
2- low birth weight < 2,5 kg
3- preterm labour < 37w
4- fetal congenital anomalies
5- breech presentation
6- transverse, oblique, unstable lie
7- second twin
8- polyhydramnios
9- unengaged presenting part
10- low lying placenta
What are the risk factors for cord prolapse that related to a procedure?
1- artificial rupture of membranes with high presenting part
2- vaginal manipulation of the fetus with rupture of membranes
3- external cephalic version
4- internal podalic version
5- Stabilizing induction of labour
6- insertion of intrauterine pressure transducer
7- large balloon catheter induction of labour
Can cord presentation be detected antenatally?
No , should not be performed
Not specific nor sensitive to identify cord presentation
How can cord prolapse or its effects be avoided?
1- transverse, oblique, unstable lie ➡️ elective admission after 38w
And advice to present if any signs of labour or rupture of membranes
2- non cephalic presentations + PPROM ➡️ offer admission
3- ARM should be avoided if presenting part is mobile
4- if ARM is necessary ➡️ should be performed with arrangements in place for immediate CS
5- cord presentation ➡️ CS
When cord prolapse should be suspected?
⚠️ it may occur without signs & normal FHR
When the umbilical cord should be examined?
1- at every vaginal examination in labour
2- after SROM IF risk factors are present
3- if CTG abnormalities commence after SROM
SROM + NO risk factors for cord prolapse, is vaginal examination indicated?
No ,it is not indicated if the liquor clear + normal FHR
Preterm gestations + suspected cord prolapse, how to manage?
Speculum and / or digital examination
What is the management of cord prolapse?
1- call for help
2- minimal cord handling to avoid vasospasm
3- NOT recommended to do manual replacement of cord and continuation of labour
What are the maneuvers in case of cord prolapse to prevent cord compression?
1- elevate the presenting part either manually or by filling the bladder by 500 - 750 ml
2- adopting the knee - chest position or head -down tilt ( in left lateral position)
3- tocolysis ( TERBUTALINE 0,25 mg SC ) while preparing for CS if persistent FHR anomalies OR when delivery is likely to delay
