this presentation is superb on cord problems

1. CORD PROLAPSE
Dr.Osheen izhar
Fcps Resident
Gynae unit-3 LGH

2. DEFINITION
• Abnormal descent of Umbilical cord by
side of presenting part is called
umbilical cord prolapse.
• Umbilical cord prolapse and cord
presentation are two different terms.
• Its an obstetric emergency and needs
prompt recognition and management
• Incidence 0.2-0.6% occurs 1:300
deliveries.

3. CLINICAL TYPES
1.OCCULT PROLAPSE
2.OVERT PROLAPSE
3.CORD PRESENTATION

4. 1.OCCULT PROLAPSE
• (Descent of umbilical cord alongside
the presenting part)
• Most difficult one to diagnose
• Presents with fetal bradycardia
prolonged decelerations

5. 2.OVERT PROLAPSE
 Descent of cord past the
presenting part
 It occurs after rupturing of
membranes.

6. 3.CORD PRESENTATION
 Present with umbilical cord
between fetal presenting part and
cervix.
 May occur with or without rupture
of membranes.
 Pulsations of cord with Intact
membranes confirm presence of
cord presentation.

7. OV E R A L L
I N C I D E N C E
The incidence of occult cord prolapse is unknown bcz it can be
detected only by fetal heart rate changes characteristic of
umbilical cord compression.
Overall incidence of overt cord prolapse is b/w 0.1% to 0.6%

8. OTHER TYPES OF CORD ACCIDENTS
True Cord Knots:
 An intertwining of a segment of
umbilical cord.
 Circulation is usually not obstructed.
 Commonly formed by the fetus
slipping through a loop of the cord.

9. NUCHAL CORD
Nuchal cord is wrapped around the
neck of the fetus in utero or of the
baby as it is being born.
It is usually possible to slip the loop
or loops of cord gently over the
child’s head.
The condition occurs in more than
25% of deliveries, more often with
long cords than that of short ones.

10. RISK FACTORS
MATERNAL FACTORS
 Rupture of membranes
 Spontaneous(Preterm ROM)
 Amniotomy(ARM)
 Pelvic tumors (Including preterm
ROM)
 Pelvic contraction
 Preterm labor
FETAL FACTORS
 Prematurity & IUGR
 Abnormal lies
 Malpresentation
 Fetal anomaly
 Multiple pregnancy
PLACENTAL FACTORS
 Polyhydramnios
 Minor degree of placenta previa

11. PROCEDURE RELATED RISK FACTORS

12. MANAGEMENT
LIFTTHE PRESENTING
PART OFTHE CORD
POSTURAL
TREATMENT
REPLACETHE CORD
INTOTHEVAGINA
CAESEREAN SECTION

13. MANAGEMENT
LIFTTHE
PRESENTING
PART OFTHE
CORD
POSTURAL
TREATMENT
REPLACETHE
CORD INTO
THEVAGINA
CAESEREAN
SECTION

14. MANAGING
OCCULT
PROLAPSE
ImmediateVE 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 continue

15. MANAGING CORD PRESENTATION
Term: CS prior to membrane rupture
Premature:
 No consensus on management
 Hospitalize patient on bed rest in Sim’s position
orTrendelenburg position
 Serial USS to ascertain cord position,
presentation and GA

16. MANAGING
CORD
PRESENTATION
Term: CS prior to membrane rupture
Premature:
 No consensus on management
 Hospitalize patient on bed rest in Sim’s
position orTrendelenburg position
 Serial USS to ascertain cord position,
presentation and GA

17. MANAGING
CORD
PROLAPSE

18. PROCEDURE RELATED RISK FACTORS

19. MANAGEMENT
LIFTTHE
PRESENTING
PART OFTHE
CORD
POSTURAL
TREATMENT
REPLACETHE
CORD INTO
THEVAGINA
CAESEREAN
SECTION

20. MANAGING
CORD PROLAPSE
Speed is of the essence and perinatal outcome is
largely dictated by diagnosis delivery interval.
Three components of management are:
1.Prevent or relieve cord compression and vasospasm
2.Fetal assessment
3.Prompt delivery of the infant

21. •PROCEDURE RELATED
RISK FACTORS

22. Speed is of the essence and perinatal outcome is largely dictated by
diagnosis delivery interval.
Three components of management are:
2.Fetal assessment
3.Prompt delivery of the infant
1.Prevent or relieve cord compression and vasospasm

28. PREVENTION
Women with transverse, oblique or
unstable lie should be offered elective
admission to hospital at 37 weeks of
gestation, or sooner if there are signs
of labour or suspicion
Women with non-cephalic
presentations and preterm pre-labour
rupture of the membranes should be
offered admission

29. PREVENTION
• Women with transverse, oblique or unstable lie
should be offered elective admission to hospital at
37 weeks of gestation, or sooner if there are signs of
labour or suspicion
• Women with non-cephalic presentations and
preterm pre-labour rupture of the membranes
should be offered admission

30. PREVENTION
Women with transverse, oblique or
unstable lie should be offered elective
admission to hospital at 37 weeks of
gestation, or sooner if there are signs
of labour or suspicion
Women with non-cephalic
presentations and preterm pre-labour
rupture of the membranes should be
offered admission

31. OPTIMAL
MODE OF
DELIVERY