3. GOALS
1. To be able to diagnose cord prolapse
2. To learn how to manage cord prolapse
3. Proper documentation
4. SALSO 2015
When part of cord falls in
front of presenting part
Membrane ruptured
Incidence:
◦ 0.5% in vertex
◦ 0.5% in frank (extended)
breech
◦ 5% in complete (flexed) breech
◦ 15% in footling breech
5. PREDISPOSING FACTORS
Fetal
◦ Prematurity
◦ Multiple gestation
◦ Anencephaly
◦ Malpresentation
◦ Breech
◦ Transverse lie
◦ Oblique
Liquor
◦ Polyhydramnios - especially
when PROM
Mother
◦ Multiparity
◦ Contracted pelvis (CPD)
◦ Pelvic tumours
Placenta & cord
– P. praevia
– Long cord
– Rupture of membranes
Iatrogenic prolapse
– ARM
– Version
– Placement of forceps or a
scalp electrode*
– Obtaining fetal scalp blood
for pH*
6. DIAGNOSIS
Appearance of loop of umbilical cord
Pulsation of cord on V/E
Suspect in unexplained fetal distress
◦ Variable decelerations
◦ Prolonged bradycardia
7. MANAGEMENT
Is baby viable?
◦ IUD - Aim for vaginal delivery
◦ Alive - aim for most expedient delivery method
◦ Instrumental delivery – if os full and expecting a
relatively easy and fast delivery
◦ Otherwise crash Caesarean section
8. Relieve cord compression
(especially during transportation)
◦ Replace cord gently into vagina
◦ Place hand in vagina, cord cradled in
palm
◦ Tips of fingers elevating presenting part
◦ Elevate the buttocks using pillow
◦ Inflation of bladder with 500 cc NS and
clamping of Foley’s catheter
DO NOT COMPRESS ON
UMBILICAL CORD !!!
