The document outlines various types of cord presentation and prolapse in obstetric emergencies, describing their definitions, predisposing factors, risk factors, diagnosis, and management. It emphasizes that cord prolapse is an emergency requiring quick delivery, often via cesarean section, while also detailing specific management strategies for different scenarios. Overall, it highlights the importance of careful monitoring and prompt intervention to ensure the health of both the mother and fetus.

1. OBSTETRIC
EMERGENCIES

4. CORD PROLAPSE , CORD
PRESENTATION

5. • When the umbilical cord lies alongside or in
front of the presenting part while the fetal
membranes are intact is known as cord
presentation
• If the fetal membranes rupture and the cord
is felt it is called cord prolapse

7. TYPES
Occult cord prolapse
• Cord is adjacent to the presenting part
• Cannot be palpated during pelvic examination.
• Might lead to variable decelerations or
unexplained fetal distress.
.

8. TYPES
Funic (cord) presentation
• Prolapse of the umbilical cord below the level
of the presenting part before the rupture of
fetal membranes
• Cord can often be easily palpated through the
membranes

9. TYPES
Overt cord prolapse
• Umbilical cord lies below the presenting part
• Associated with rupture of membranes, and
displacement of the cord through the vagina

12. Predisposing factors
• Malposition
• Malpresenation
• Cephalopelvic disproportion
• Polyhydramnious
• Prematurity

13. MATERNAL and PLACENTAL
factors
MATERNAL
❑ Rupture of membranes
❑ Spontaneous (including preterm ROM)
❑ Amniotomy (ARM)
❑ Pelvic tumors e.g cervical fibroid
❑ Pelvic contraction
❑ Preterm labour
PLACENTAL
• Polyhydramnios
• Minor degree of placenta previa

14. Aetiology/ Risk Factors
• Cord abnormalities (such as true knots or low content of
Wharton’s jelly)
• Fetal hypoxia-acidosis may alter the turgidity of the cord
and predispose to prolapse.

15. Aetiology/ Risk Factors
• PROCEDURE- RELATED
• Amniotomy
• External Cephalic Version
• Internal Podalic Version
• Stabilizing Induction of labor
• Applying fetal scalp electrode
• Amnion infusion
• Placement of a cervical ripening balloon catheter

16. • Complication
• Fetal distress
• Fetal anoxia
• Fetal death
• Emergency operative intervention
• Cord compression
• Umbilical artery vasospasm
• Hypoxic-Ischemic Perinatal death
• Encephalopathy

17. DIAGNOSIS
• Cord presentation and prolapse may occur without outward
physical signs.
• Suspected during clinical examinations
• abnormal fetal heart rate pattern may suggest overt or occult
cord prolapse
• (bradycardia, marked variable decelerations etc) in the
presence of ruptured membranes, particularly if such changes
occur soon after membrane rupture, spontaneously or with
amniotomy

18. VAGINAL EXAMINATION
• Sudden appearance of a loop of umbilical cord at
the introitus, usually just after membrane rupture
• May palpate cord during a vaginal examination
in the absence of intact membranes
• Cord presentation, sometimes felt below the
presenting part when membranes are intact.

19. MANAGEMENT
• Cord prolapse is an obstetric emergency and delivery
must be as quick as possible
• C/S is necessarily except if :
• The cervix is fully dilated and the presenting
• part is engaged forceps or vacuum can be
• performed by experienced obstetrician.
• ◒ Death fetus with no other indication for C/S allow
vaginal delivery.

20. • As soon as the diagnoses is made the cord
should be handled as little as possible to
avoid arterial spasm
• Pressure on the cord can be reduced by
displacing the presenting part by hand in the
vagina or
• by placing the patient in the knee-chest
position

21. • Syntocin should be stopped if it was used
• Investigation should be sent urgently
• Patient should be transferred to the operating theater
for emergency C/S
• The pediatrician should be informed to attend the
delivery

22. MANAGEMENT OF OCCULT PROLAPSE
• Immediate vaginal examination to rule out cord
prolapse
• Left lateral position
• O2 to mother
• Discontinue oxytocin infusion if in place
• Allow labor to progress if FH returns to normal and
no further insult.
• Continuous fetal heart rate monitoring
• Amnioinfusion
• CS if cord compression pattern continues

23. AMNIOINFUSION

24. MANAGEMENT CORD PRESENTATION
• Term: CS prior to membrane rupture.
• Premature: No consensus on management
• Hospitalize patient on bed rest in Sim’s
position or Tredelenburg position
• Serial USS to ascertain cord position,
presentation and GA 20

26. MANAGEMENT OF OVERT CORD
PROLAPSE
• Speed is of the essence and perinatal
outcome is largely dictated by the
diagnosis-delivery interval.
• The three components of management
are:
1. Prevent or relieve cord compression and
vasospasm
2. Fetal assessment
3. Prompt delivery of the infant

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