Cord prolapse occurs when part of the umbilical cord falls in front of the presenting fetal part after rupture of membranes. It is diagnosed by seeing a loop of cord or feeling pulsations on vaginal exam and can cause variable or prolonged fetal decelerations. Management depends on fetal viability - for living fetuses, the most expedient delivery by instrumental delivery or C-section is recommended, while relieving cord compression and replacing it in the vagina. Proper positioning and filling the maternal bladder can help alleviate compression until delivery.

1. CORD PROLAPSE

2. GOALS
1. To be able to diagnose cord prolapse
2. To learn how to manage cord prolapse
3. Proper documentation

3. SALSO 2015
 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

4. 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*

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

6. 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

7.  Relieve cord compression
 Replace cord gently into vagina
 Place hand in vagina, cord cradled
in palm
 Tips of fingers elevating presenting
part
 Elevate the buttocks using pillow
DO NOT COMPRESS ON
UMBILICAL CORD !!!

8.  Fill bladder (16 Foley catheter, 500-800ml of saline)
 Mother in trendelenburg or knee-chest position

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