This document discusses different types of umbilical cord complications during delivery, including cord prolapse, cord presentation, and occult prolapse. It defines each type and notes their incidence is about 1 in 300 deliveries. Risk factors include malpresentations, contracted pelvis, and prematurity. Diagnosis involves feeling for pulsation through the intact membranes or by direct visualization. Management is discussed briefly. Vasa previa is also summarized, defined as fetal vessels running in close proximity to the inner os, putting them at risk of rupture during membrane rupture. Incidence is highest with velamentous cord insertion or multiple gestation. Immediate delivery or C-section is recommended for management.

1. CORD PROLAPSE & CORD
PRESENTATION

2. DEFINITION:
Abnormal descent of the umbilical cord by the side
of presenting part is called as Cord prolapse.
TYPES:
1. Occult prolapse: here cord is placed by side of
presenting part but is not felt on doing int. exam.
2. Cord presentation: here cord is slipped down
below the presenting part & is felt lying in the
intact bag of membranes.
3. Cord prolapse: cord is lying inside the vagina or
outside the vulva following ROM

3. Occult
Prolapse
Cord
presentation
Cord
Prolapse

4. INCIDENCE:
• 1 in 300 deliveries
• More common in parous women
ETIOLOGY:
• Malpresentations
• Contracted pelvis
• Prematurity
• Multiple gestation
• Hydramnios
• Minor degree of Placenta praevia/marginal
insertion of cord / long cord
• Iatrogenis-LROM, version.

5. DIAGNOSIS:
• Occult prolapse: is difficult to diagnose
• Cord presentation: feeling the pulsation of cord
through intact membranes
• Cord prolapse: direct visualization or its palpation
& feeling of its pulsation

6. MANAGEMENT
(schematic mngt)

7. VASA PRAEVIA

8. INTRODUCTION
• Vasa praevia is defined as
"fetal vessels crossing or
running in close proximity to
the inner os.”
• These vessels course within
the membranes & are at risk
of rupture when the
supporting membranes
rupture.

9. INCIDENCE: It is most commonly associated with:
• Velamentous insertion of cord,
• multiple gestation,
• succenturiate lobe of placenta
MANAGEMENT:
• Immediate vaginal delivery or CS
• Check fetal blood studies
• Start blood transfusion immediately.
• Continuous monitoring of newborn & mother.

10. AMNIOTIC FLUID INDEX:
• Amniotic fluid embolism is a rare obstetric
emergency in which amniotic fluid enters the
mother's blood stream via a rent in the membranes
or placenta which results in cardio-respiratory
collapse and DIC.
• CAUSE: ruptured membranes, procedures like
amniocentesis, etc.
• FEATURES: Dyspnea, hypotension, respiratory
arrest, cardiac arrest.
• TREATMENT: Emergency CS.

11. Thank you..!!