This document discusses umbilical cord prolapse, which occurs when the umbilical cord slips below the presenting fetal part and out of the uterus. It has an incidence of about 1 in 300 deliveries. Risk factors include polyhydramnios, multiple gestation, and procedures done before engagement of the fetal head. Diagnosis involves feeling pulsations in the cord. Management involves relieving pressure on the cord, positioning the mother, monitoring the fetus, and immediate delivery of the baby, usually by c-section if the baby is alive or waiting for spontaneous delivery if the baby is dead.

2. Types
 Occult prolapse – cord is prolapsed by side of presenting
part & it’s not felt by fingers on internal examination.
 Cord persentation- cord is slipped down below prenting part &
is felt lying in the intact beg of membranes.
 Cord prolapse-cord lying inside of vagina or outside of vulva
following ROM.

3. UMBILICAL CORD PROLAPSE

5. Cord prolapse

6. Incidence & etiology
 Incidence of cord prolapse is 1 in 300 deliveries.
 Mostly found in parous women.
 Etiology- Anything which interfere with perfect
adaption of presenting part to lower uterine segment
in it more than one factor operates .

7. Umbilical Cord Prolapse
 Precipitating factors:
 Long umbilical cord
 Abnormal location on
placenta
 Small or preterm infant
 Polyhydramnios
 Multiple gestation
 Precipitating factors:
 Amniotomy before fetal
head is engaged
 External cephalic
version
 Malpresentation
( Transverse common )
 Contracted pelvis

8. Umbilical Cord Prolapse
 Clinical Manifestations:
 Cord observed or palpated
 Bradycardia following ROM
 Repetitive, variable decelerations that do not respond to
medical intervention (e.g. amnioinfusion)
 Prolonged decelerations (>15 bpm lasting 2 mins or
longer yet <10 mins)

9. DIAGNOSIS
 Occult prolapse – persistence of variable deceleration
of fetal heart rate pattern
 Cord presentation – feeling the pulsation of the cord
through the intact membrane
 Cord prolapse – cord directly palpated by fingers and
its pulsation can be felt if the fetus is alive

10. management
 Nursing interventions:
 Assess fetal viability
 Call for assistance
 Relieve pressure from cord (usually presenting part)
 Continuous manual relief of pressure from presenting part
 Avoid excessive manipulation of cord
 Re-position client: Trendelenburg, modified Sim’s, or knee-chest
 Prepare for emergency delivery
 Administer oxygen by mask 10-12 L/min
 Fill maternal bladder with 500-700 ml NS
 Continuous fetal monitoring
 Possible neonatal resuscitation (notify neonatal team per hospital
protocol)

11. Umbilical Cord Prolapse
 Aim of Medical management:-
 Immediate delivery of viable infant- in vertex by
forceps (head low down) or ventouse (Head high up).
 in breech in expert hands only.
 If baby dead then confirm by USG, wait for spontaneous
delivery, or destructive operation.
 Hallmark treatment: C-section