Unit - VIII Abnormal Labour - Cord Prolapse

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MIDWIFERY AND OBSTETRICAL NURSING
B.Sc (Nursing) IV Year
UNIT - VIII
LESSON PLAN
ON
CORD PROLAPSE

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LESSON PLAN
Name of the Institution : GRT College of Nursing
Name of the subject : Midwifery and Obstetrical Nursing
Unit : VIII
Topic : Cord Prolapse
Duration : 30 mts
Venue : GRT CON IV Yr Classroom.
Method of teaching : Lecture cum discussion
A.V aids : Chalkboard, Handout, Chart & PPT Presentation
Name of the Presenter : Mrs.Nirmala.M, M.Sc(N), MBA,
Associate Professor,
GRT College of Nursing, Tiruttani.
General objective:
The students will acquire in depth knowledge regarding cord prolapse, develop desirable attitude and skill in rendering nursing care to the
mother with cord prolapse.
Specific Objectives:
At the end of the class the student will be able to,
 define cord prolapse
 enlist the types of cord prolapse
 list down the etiology of cord prolapse
 identify the signs & symptoms of cord prolapse
 notify the diagnostic evaluation for the cord prolapse
 explain the preventive measures of cord prolapse
 discuss the emergency care and management of cord prolapse
 describe the management of cord prolapse during labor

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INTRODUCTION
Good Morning my dear students!
Now I am going to say an interesting case scenario, through this you will be able to identify the topic which I am going deal with it.
Case Scenario: A term antenatal mother came to a Maternity hospital with PV leaking but no abdominal pain and no uterine contraction
and She adds on, something like a soft loop is come out of the vagina and causing irritation in between the thighs. On her examination,
FHR shows variability of late deceleration and bradycardia.
 Can anyone find the condition of the mother
 And what it is?
Umbilical Cord prolapse may be occult (hidden, not visible) at any time during labor whether or not the membranes ruptured. It is
most common to see frank (visible) prolapse directly after rupture of membrane when gravity washes the cord in front of the presenting
part.

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Time
Specific
Objective
Contents
Teaching &
Learning Activity
A.V Aids Evaluation
2 min define cord
prolapse
DEFINITION
Cord prolapse has been defined as the descent of the umbilical cord
through the cervix alongside (occult) or past the presenting part (overt) in the
presence of ruptured membranes. Cord presentation is the presence of the
umbilical cord between the fetal presenting part and the cervix, with or without
membrane rupture.
Umbilical cord shows descent in relation to fetal presenting part mostly
during labor, rarely during the pregnancy in premature. It is the abnormal descent
of the umbilical cord by the side of the presenting part.
The teacher teaches
definition with use
of chalkboard
The students listens
and copies down
Chalkboard Can anyone
define the
cord prolapse
2 min enlist the types
of cord
prolapse
TYPES:
It is classified into
1. Before rupture of membranes:
a. Occult cord presentation – the loop of cord lies beside presentation
b. Cord presentation – loop of cord descends below presentation
2. After the rupture of the membranes
a. Occult cord prolapse – loop of cord lying beside presentation
Cord prolapse – loop of cord descends below presentation in cervix, vagina and
even outside.
The teacher lists the
types of cord
prolapse with help
of chart
The students listen
and understand
Chart List down the
types of cord
prolapse after
rupture of
membranes

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2 min state the
incidence
INCIDENCE:
1 in 300 deliveries
Estimates of the incidence of umbilical cord prolapse range from 1.4 to
6.2 per 1,000.
The perinatal mortality rate from cord prolapse is 91 per 1,000.
Overt cord prolapse occurs in more than 1% breech deliveries:
o 0.5% cephalic and frank breech presentations.
o 5% complete breech.
o 15% footling breech.
Transverse lie is associated with a risk of cord prolapse as high as 20%.
The incidence of occult prolapse is unknown but 50% of monitored
labours show fetal heart rate changes suggesting umbilical cord
compression.
The teacher writes
the incidence on the
chalk board
The students
observes and copies
down
Chalkboard Mention the
incidence of
cord prolapse
in breech
delivery

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3 min list down the
etiology of
cord prolapse
ETIOLOGY & RISK FACTORS:
Fetal Congenital abnormality
Malpresentation – oblique, transverse and unstable lie
Abnormal presentation and position of the head – Breech presentation,
face and brow presentation, shoulder presentation and occipito posterior
position
Contracted pelvis & cephalon pelvic disproportion
Prematurity
Multiparity
Twins
Low birth weight baby (<2.5 kg)
Macrosomia
Hydramnios
Placental Factor – Minor degree of placenta previa
Iatrogenic – Low Rupture of membranes, manual rotation of head and
version
A long umbilical cord
Pelvic Tumors
The teacher list
down the etiology
and risk factors of
cord prolapse with
help of handout
The students listen
and understand
Handout Enumerate
the etiology
and risk
factors of
cord prolapse
2 min Identify the
signs &
symptoms of
cord prolapse
SIGNS & SYMPTOMS:
Cord prolapse may occur with no outward physical signs and a normal
FHR.
Non-engaged or ill-fitting head
Feeling the pulsation of the cord through intact membranes
The teacher teaches
with chalkboard
The students
understand
Chalkboard Mention the
few s/s of
cord prolapse

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Cord can be seen protruding from introitus or a bluish shiny loop of cord
can be palpated within the vaginal canal
2 min notify the
diagnostic
evaluation for
the cord
prolapse
DIAGNOSIS:
 History collection
 Physical examination, Obstetrical examination – ill-fitting or non-engaged
head, Per vaginal examination – Cord can be seen protruding from
introitus or a bluish shiny loop of cord can be palpated within the vaginal
canal.
 Occult prolapse is very difficult to diagnose
 Cord presentation can be diagnosed by feeling the pulsation of the cord
through intact membranes
 Cord prolapse – cord palpated directly by the fingers and its pulsation can
be felt if the fetus is alive
 Ultrasound is also done to detect cord loop in the cord presentation
 A vaginal examination might show the bluish shiny cord protruding
through the cervix
The teacher explains
the diagnostic
measures with help
of PPT presentation
The students
observe and
understand
PPT
presentation
Enlist the
diagnostic
measures of
cord prolapse
2 min List down the
complication
of cord
prolapse
COMPLICATIONS:
Hypoxia
Hypoxic-ischemic encephalopathy/ birth asphyxia
Cerebral palsy
Permanent brain damage
Stillbirth
The teacher writes
on the chalkboard
The students
observes and copies
down
Chalkboard State the
complications
of Cord
prolapse

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5 min explain the
preventive
measures of
cord prolapse
TREATMENT OF CORD PROLAPSE:
PREVENTIVE MEASURES:
1. If the cord is pulsating, the nurse should prevent pressure on the cord by
putting the mother in any of the following positions:
a. Knee chest – the foot of the bed should be raised high or the patient
put in the genu-pectoral knee chest position till the arrival of
hospital. This is efficient in preventing cord compression but is very
uncomfortable for the mother
b. Extreme Trendelenburg position
The teacher explains
the preventive
measures with help
of PPT Presentation
The students
observe and
understand
PPT
Presentation
Can anyone
explain the
schematic
presentation
of
management

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c. Sim’s Lateral position – most comfortable position, mother’s pelvis
is raised on pillows
2. If the presenting part is high, any attempt to replace cord may fail. It is
better to prevent spasm of the umbilical vessels by wrapping the cord in
sterile gauze dipped in warm saline solution.
3. If the mother is at home, an immediate attempt is made to transfer the
mother to hospital by quickest and safest method of transportation.
4. As cord presentation and cord prolapse are serious complications, hence it
should be promptly recognized that a little delay may lead to fetal hypoxia.
Occlusion of blood flow to and from the fetus for more than 5 minutes
usually results in CNS damage or death of the fetus.

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5 min discuss the
emergency
care and
management
of cord
prolapse
EMERGENCY TREATMENT:
An emergency situation, a woman may present the following signs:
1. Fetal bradycardia – with variable deceleration during uterine contraction
2. Woman reports feeling the cord after membranes rupture
3. Cord is seen or felt in protruding from the vagina
Emergency Care:
1. Call for assistance
2. Notify primary healthcare provider immediately
3. Glove the examining hand quickly and insert two fingers into the vagina
to the cervix with one finger on either side of the cord or both fingers to
one side, exert upward pressure against the presenting part to relieve
compression of the cord. Place a rolled towel under the woman’s right or
left hip.
4. Place the woman in – Extreme Trendelenburg, a modified sim’s position,
a knee chest position.
5. If the cord is protruding from vagina, wrap it loosely in a sterile towel
saturated with warm sterile normal saline solution
The teacher details
the management of
cord prolapse with
PPT Presentation
PPT
Presentation
Mention the
position to be
maintained in
emergency
situation

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6. Administer oxygen to the woman by mask at 8 – 10 liters/mt until the birth
of the baby.
7. Start IV Fluid or increase existing drip rate
8. Monitor FHR by internal fetal scalp electrode, if possible.
9. Give her psychological support and explain her what is happening and the
way it is being managed.
10. Prepare for immediate vaginal delivery, if the cervix is fully dilated or
caesarean birth, if it is not dilated.
5 min describe the
management
of cord
prolapse
during labor
MANAGEMENT OF CORD PROLAPSE DURING LABOUR:
1. If the cord prolapse occurs during the first stage of the labor, the nurse
prepares the operation theatre and the mother for cesarean section after
giving emergency treatment
2. If the mother is in the second stage of labor and the physician is not
immediately available, an episiotomy should be done, fundal pressure is
applied and the fetus is delivered
3. Before conducting delivery, note the dilatation of cervix
4. If the cervix is fully dilated, a forceps or vacuum assisted birth can be done
for the fetus in a cephalic presentation
The teacher details
the management of
cord prolapse with
PPT Presentation
The students listen
and understand
PPT
Presentation
Can anyone
brief out the
management
of cord
prolapse
during labour

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5. If the condition of the mother is deteriorating and cervical dilatation is not
occurring, then baby is delivered by a caesarean section.
ASSIGNMENT:
Date of Submission: _________ Marks: 10
Case Scenario: A 26 yrs old Primigravida mother at 37 wks + 5 days present
with complaints PV leaking since morning 5 am and something is fallen out from
the vagina and causing discomfort to her.
 Write the nursing process for the above case scenario (Cord prolapse)
EVALUATION: Date of Examination: ______ Time: 20 mts Marks: 10
1. Define cord prolapse?
2. List down the types of cord prolapse
3. Mention the etiology of cord prolapse
4. Identify the measures to prevent cord prolapse
5. Write the management of cord prolapse during labour.
SUMMARY:
Today we have learned about cord prolapse, types according to intact
membrane & ruptured membrane, etiology, diagnosis, management of cord
prolapse during pregnancy and labour and preventive measures of cord prolapse.
CONCLUSION:
Cord prolapse is a loop of cord lies beside or in front of the presenting part
or loops out from cervix, vagina and even outside. It can happen at any point of

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time, viz., before rupturing of membrane or after rupturing of membrane and at
the end of the pregnancy or at the time delivering process. As a nursing personnel
we need to be more vigilant and careful while taking care of such kind of mother.
Do not leave a woman in the labor room alone and have continuous watch on
mother to notify early complications and plan treatment at the earliest in order
to prevent complications.
BIBLIOGRAPHY:
1. Shally Magon & Sanju Sira, (2021), “Midwifery and Obstetrics” 1st
edition, Lotus Publication, Jalandhar, Pg No. 520 – 522.
2. Asahina R, Tsuda H, Nishiko Y, et al; Evaluation of the risk of umbilical
cord prolapse in the second twin during vaginal delivery: a retrospective
cohort study. BMJ Open. 2021 Jun 1611(6):e046616. doi:
10.1136/bmjopen-2020-046616.
3. Boushra M, Stone A, Rathbun KM. Umbilical Cord Prolapse
(https://www.ncbi.nlm.nih.gov/books/NBK542241/). 2022 Jun 5. In:
StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022
Jan-. Accessed 3/7/2023.
4. Kawakita T, Huang CC, Landy HJ; Risk Factors for Umbilical Cord
Prolapse at the Time of Artificial Rupture of Membranes. AJP Rep. 2018
Apr8(2):e89-e94. doi: 10.1055/s-0038-1649486. Epub 2018 May 10.
THANK YOU!!!