SALSO Series - Cord Prolapse

1. CORD PROLAPSECORD PROLAPSE
SALSOSALSO
COURSECOURSE

2. Cord Prolapse
♦ When part of cord falls in front of presenting
part
♦ Membrane ruptured
♦ Incidence:
0.2-0.4% in vertex
0.5% in frank (extended) breech 4-6%
in complete (flexed) breech 15-18% in
footling breech

3. 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*

4. DIAGNOSIS
♦ Appearance of loop of umbilical cord
♦ Pulsation of cord on V/E
♦ Suspect in unexplained fetal distress
– Variable decelerations
– Prolonged bradycardia

5. 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

6. ♦ Relieve cord compression
– Replace cord gently into vagina
– Place hand in vagina, cord cradled in palm
– Tips of fingers elevating presenting part
– Mother in trendelenburg or knee-chest position
– Fill bladder (16 Foley catheter, 500-800ml of saline)

7. ♦ Continuation of relieving of cord
compression during
– Induction of anaesthesia
– Placement of sterile sheet
– LSCS
♦ Remove hands only when the surgeon tells
you!