cord presentation

1. Unstable lie
Cord presentation and Cord prolapse
Fetal Distress
AL Dr AungBoBoWin
Central Women’s Hospital

2. Unstable Lie
Definition: presentation of the fetus is frequently
changing after 36 weeks of pregnancy.
Causes:
 Grandmultip with lax and pendulous abdomen.
 Polyhydramnios
 Contracted pelvis
 Placenta praevia
 Pelvic tumour

3. Management of Unstable Lie
1.Antenatal management
Check presentatin and lie at each visit
ECV after 37 weeks if there is no contraindication
Hospitalization at 38 weeks due to danger of early
rupture of membranes and cord prolapse.

4. 2.Management during delivery
(1) Elective CS if there is complicating factors.
(2) Stabilising induction to prevent further reversion.
Presentation checked
ECV if necessary
Syntocinon drip to induce effective uterine
contraction
Controlled ARM ( risk of cord prolapse)

5. Cord presentation and Prolapse
Definition:
Cord presentation. . . when a segment of umbilical cord is
present at the cervical os before the rupture of membranes.
Cord prolapse. . . when the cord is present in the vagina
from any level from upper vagina to outside the introitus
when membrane ruptured.

6. Causes. . . . presenting part is high above the pelvis
or if it does not fit well into the pelvis at the time of
rupture of the membrane. eg.
transverse lie
cephalo pelvic disproportion
preterm labour
breech presentation
multiple pregnancy.

7. Management
1.Cord presentation
Emergency CS.
If os is nearly full →forceps or breech extraction.
2. Cord prolapse
If the baby is alive and cervix is not fully dilated
→emergency CS.
If the baby is alive and cervix is fully dilated
→forceps delivery or breech extraction ( for breech
presentation).

8. First Aid management:
Replace the exposed cord into vagina to keep it warm
and prevent vasospasm.
Lift the presenting part with the examining hand to keep
pressure off the cord.
Keep the patient in knee chest or exaggerated Sim’s
position to replace the cord into vagina.
Fill the bladder with 750 ml of normal saline by Foley’s
catheter.

9. Cord Prolapse
Cord pulsation +/-
Cord pulsation (+) Cord pulsation (-)

10. Cord
pulsation
(+)
Cord
pulsation
(-)
Os full
Os not full
Head
Breech
Forceps
Breech
extraction
Em LSCS
Head/Breech
Longitudinal lie
No complication
NSVD
Transverse lie
Placenta praevia
Em LSCS