Hi, myself Dipanwita Maity ,' Clinical Instructor ' of 'Shova Rani Nursing College ' (A unit of KPC Medical College & Hospital , Jadavpur , Kolkata ) , am sharing my PPT on "Cord Prolapse"( Subject: Midwifery & Obstetrical Nursing ) with all of you .

1. CASE PRESENTATION
ON
CORD PROLAPSE
Presented By:
Dipanwita Maity,
4th Year,B.Sc. Nursing
Roll: 33,
Shova Rani Nursing
College.

3. DEFINITION
Cord Prolapse is the descend of umbilical
cord into the lower uterine segment where it
may lie adjacent to the presenting part or
below its presenting part, without intact fetal
membranes.
When membranes are intact ,it’s called
Cord Presentation.

4. INCIDENCE RATE OF CORD PROLAPSE
Cephalic
0.3-
0.4%
Breech
Flexed
(Frank)
0.4-0.5%
Complete
5%
Footling 15% Transeverse
Lie 20%

5. Related Anatomy and Physiology

6. Etiology of Cord Prolapse
1) Malpresentation
- Contracted Pelvis
- Prematurity
- Twins
- Hydramnios
2) Placentalfactors
3) Iatrogenic
4) Others
- Multiparity
- Congenital anomalies

7. TYPES OF CORD PROLAPSE
1)Occult Prolapse 2)Cord Presentation 3)Cord Prolapse
The cord is not The cord is slipp The cord is
placed by the -ed down below lying inside
side of the the presenting the vagina
Presenting part part and is felt or outside
and is not felt lying in the the vulva
by the fingers intact bag of following the
on internal membranes. Rupture of
examination.Seen membranes.
on USG or during
C-Section.

8. Types Of Cord Prolapse

9. • Diagnosis Of Cord Prolapse :
• - History taking & Physical examination
• - Abnormal fetal heart rate (< 140 beats/ minute)
• - Pelvic & Vaginal examination . Sudden
apperance of loop of umbilical cord at the time
just usually just after membrane rupture .
• - Doppler sound imaging .
• - Prenatal ultrasound scans before delivery .

10. • CONSEQUENCES
• Cord compression Umbilical artery
• vasospasm
•
• Birth Asphyxia
• Hypoxic Ischemic Perinatal death
• Encephalopathy

11. MANAGEMENT
1) COLLABORATIVE MANAGEMENT
• CORD PRESENTATION:
▪ No attempt should be made to replace the cord
,once diagnosis is made.
▪ If immediate vaginal delivery is not possible or
contraindicated , caesarean section is the best
method of delivery .

12. • CORD PROLAPSE :
Management protocol is guided by –
1) Baby living or dead
2) Maturity of the baby
3) Degree of cervix dialatation

13. MANAGEMENT
•Baby living:
•1) Definitivetreatment- caesarean section
•2) Immediate safe vaginal delivery is possible-
- Forceps delivery – if head is engaged.
- Breech extraction- in breech presentation.
- Internal version followed by breech
extraction : in Transverse lie

14. MANAGEMENT
3) Immediate safe vaginal delivery is not
possible:
➢ First-aid management:
• Minimize pressure on the cord till when the patient is
prepared for assisted deliveryor transferred tohospital.Stop
oxytocin infusion, if continuous.Administer IVfluid& O2.
• Bladder filling with 400-750ml NS and the balloonis inflated
and clamp the catheter.
•Lift the presenting part off the cord.
•Trendelenburg or knee-chest position. Sim’s position.

15. Knee-chest Position
Trendelenburg
Position

16. • MANAGEMENT
•
• Baby Dead :
• Labour is allowed to proceed awaiting
spontaneous delivery

18. MANAGEMENT

19. COMPLICATIONS
- Failed induction
- Uterine hyper stimulation
- Prematurity
- Infection
- Bleeding
- Uterine rupture