An occult or overt prolapsed umbilical cord occurs when the umbilical cord falls in front of, lies beside, or hangs below the fetal presenting part during delivery. It is an obstetric emergency that requires immediate intervention to prevent fetal hypoxia and associated increased morbidity and mortality. Risk factors include prematurity, multiple pregnancy, polyhydramnios, and malpresentations. Management of prolapsed cord involves preparing for immediate delivery, positioning the patient, administering oxygen, and manually elevating the presenting part and separating the cord until an emergency cesarean delivery or expedited vaginal delivery can be performed.

1. OBSTETRICS
Prolapsed umbilical cord
By
BAHAIA ALI
MD OBG

2. Prolapsed umbilical cord
▪ Prolapsed umbilical cord is a portion of the
umbilical cord that falls in front of, lies beside, or hangs
below the fetal presenting part. Umbilical cord prolapse is
an obstetric emergency that requires immediate
intervention to prevent fetal hypoxia. Delayed
management is associated with significantly increased
morbidity and mortality

3. TYPES
OF PROLAPSED UMBILICAL CORDS
❖can be occult or overt
1. An occult prolapse is hidden. It can't be seen or
felt during a vaginal examination

4. An overt prolapse can be seen protruding
from the vagina and precedes the fetus'
head or presented part

5. Assessment findings
sudden appearance of a loop of umbilical cord at the
introitus after rupture of the amniotic membranes
fetal heart rate decelerations after rupture of the amniotic
membranes that don't resolve with position changes
fetal bradycardia with rupture of the amniotic membranes
a visible or palpable umbilical cord on vaginal examination

6. Risk
factors
Prematurity
Multiple
pregnancy Polyhydramnios Malpresentations
Obstetric manipulation

7. WHEN YOU
SUSPECTED CORD
PROLAPSE AS HEALTH
CARE PROVIDER?
when you note an abnormal fetal heart rate (FHR)
pattern, particularly if it occurs soon after
membrane rupture, spontaneously, or with
amniotomy

8. Management
•Cord prolapse is an obstetric emergency
➢ prepare for immediate delivery
➢ Explain emergency measures and their rationales to the patient and support person to increase
their understanding and enhance cooperation
➢ Obtain consent for delivery, as indicated
➢ Help the patient into a knee-chest, Trendelenburg, or left-lateral Sims position and then elevate
the buttocks using pillows to reduce pressure from the presenting part on the cord prolapse
➢ Administer oxygen to the patient via a mask, to improve fetal oxygenation
➢ perform hand hygiene and put on sterile gloves and place a gloved hand in the patient's vagina
to elevate the presenting part and to separate the cord from the presenting part and bony
pelvis
➢ Don't remove your hand until the neonate can be delivered by emergency cesarean birth if
cervical dilation is incomplete.
➢ If the cervix is fully dilated, may deliver the neonate quickly using forceps.