Table Of Contents
Cord Polapse
Umbilical cord prolapse is protrusion of the umbilical cord ahead of or alongside the presenting part of the fetus. Cord prolapse is a serious obstetric emergency**,** especially when it is visible (overt prolapse). The most common cause is rupture of membranes when the presenting part is not engaged. The cord should NOT be touched or attempt to return it into the uterus since this will cause reflex vasospasm.
The incidence of cord prolapse is 0.1 – 0.6% of births.
Types of cord prolapse
| Type | Definition |
|---|---|
| Occult prolpase | Cord prolapses alongside the head of the fetus. Membranes are still intact – can’t see, difficult to feel. Noted with changing fetal heart rate pattern (prolonged bradycardia or variable decelerations) |
| Funic presentation | Cord prolapses over the presenting part of the fetus i.e. the umbilical cord is the presenting part. Membranes are still intact. This is different from vasa previa as funic presentation is usually mobile |
| Overt prolapse | Visible cord prolpase. Membranes have ruptured. |
- Risk factors (HIGH RISK CORD)
- Breech presentation (especially footling breech)
- High presenting part (not engaged)
- Transverse lie
- Amniotomy (before presenting part engages)
- External cephalic version
- Fetal anomalies
- Cord abnormalitis
- Polyhydramnios (more room for the umbilical cord to move)
- Multiple gestation (more room, more cords, and especially the second twin)
- Spontaneous rupture of membranes
- Preterm Prelabour Rupture of Membranes (PPROM)
- Grand multiparity (≥ 5 P = lax abdominal wall with unstable lie)
- Uterine anomaly
- Pathophysiology
- Compression of the umbilical cord → reduced blood supply to the fetus → hypoxia → stillbirth, hypoxic-ischemic encephalopathy, cerebral palsy
- Treatment
- Call for help
- Inform theatre and anaesthetists and prepare for emergency caesarean delivery
- Avoid handling the cord (will cause vasoconstriction)
- Check for pulsatility (if pulsatile the fetus is viable)
- Put mother in knee-chest position or exagerrated Sim’s position and elevate the presenting part to relieve pressure on the cord. Can also instill the bladder with 500 – 750 ml of saline to minimize compression
- Give oxygen and tocolyze if the mother is in labour (to reduce contractions and maintain uteroplacental blood flow)
- If there is abnormal fetal heart rate relieve pressure on the cord by lifting the presenting part
- Determine dilatation of the cervix, station, and presenting part in theatre
- Delivery
- Emergency Caesarean delivery
- Vaginal delivery if OS is fully dilated, longitudinal lie and presenting part is at the pelvic floor
- Expectant management if there is intrauterine fetal demise
