Meaning, types, incidence, etiology, Diagnosis, management

2. Cord
Prolapse

3. DEFINITION:
Abnormal descent of umbilical cord by the
side of presenting part is called as cord
prolapse.

4. TYPES
• Occult prolapse –
The cord is placed by
the side of the
presenting part and is
not felt by fingers

5. • Cord presentation –
The cord is slipped down
below the presenting
part and is felt laying in
the intact bag of
membranes.

6. • Cord prolapse –
The cord is laying
inside the vagina or
outside the vulva
following rupture of
membranes.

7. INCIDENCE:
• 1:300 deliveries.
• Mostly confined to parous women
• Incidence is reduce with the increased use
of elective CS in noncephalic presentations.

8. ETIOLOGY:
• Anything which interference with perfect
adaptation of the presenting part to the
lower uterine segment, disturbing the ball
valve action may favor cord prolapse.

9. The following are the associated factors:
1. Malpresentation – the most common being
Transverse lie
presentation (5-10%)

10. Breech(3%)especially with flexed leg or
footling and compound (10%)
Breech presentation
Flexed leg or Footling
Compound
presentation

11. 2.Contracted pelvis
3. Prematurity

12. 4. Twins
5. Hydramnios

13. 6.Placetal factor- Minor degree of placenta
previa with marginal insertion of cord or long
cord

14. 7. Iatrogenic -
8. Stabilizing induction
Low rupture of the
membrane
Manual rotation of
the head
External cephalic
version

15. DIAGNOSIS:
Occult prolapse
• Continuous
electronic fetal
monitoring
Cord
presentation
• Feeling the
pulsation of the
cord through the
intact
membranes
Cord prolapse
• The cord is
palpated
directly by the
fingers and it’s
pulsation can be
felt if the fetus is
alive
• Auscultation for
FHS
• USG for cardiac
movements

16. EARLY DETECTION:
1. Internal
examination
(Whenever the
membrane rupture
prematurely or
during labor in all
cases of
malpresentation)
2. Surgical
induction
(everything ready
for CS)
- Uterine
contraction is
initiated by oxytocin
- If the head is not
engaged prior to
low rupture of the
membranes.
-Internal
examination both
before and after
amniotomy should
be done
3. One
should
exclude cord
presentation
or cord
prolapse, in
unexplained
fetal distress
during labor

17. MANAGEMENT:
• Cord Presentation:
Once the diagnosis is
made ,no attempt should
be made to replace the
cord
If immediate vaginal
delivery is not possible
or contraindicated,
cesarean section is the
best method of delivery
A rare occasion watchful
expectancy can be adopted till
full dilatation of cervix.
Delivery can be completed by
forceps or breech extraction

18. Baby alive Baby dead
CS delivery
(Treatment of
choice
Immediate
vaginal
delivery not
possible
Immediate safe
vaginal delivery
possible
First aid Definite management
Vertex
Forceps or
Ventouse
Breech
Breach extraction in
expert hands only
•Conform with USG
•Wait for spontaneous
delivery or
•Destructive operation
•Baby living or dead
•Maturity of the baby
•Cervical dilatation
Cesarean section
Cord prolapse

19. • Bladder filling
• To lift presenting part of the cord
• Posture – exaggerated and elevated Sims
position or Trendelenburg or knee chest
position – to refer to an equipped hospital

20. •To replace the cord into vagina to
minimize vasospasm due to irritation
Baby dead:
• Labor is allowed to
proceed awaiting spontaneous
delivery

21. PROGNOSIS
Maternal
• The fetus is at risk of
anoxia from the moment
cord is prolapsed
• The hazards due to the
fetus is more in vertex
presentation.
• Perinatal mortality is
about 15-50%
Fetal
• The maternal risks are
incidental due to
emergency operative
delivery, especially through
the vaginal route.
• Operative delivery involves
the risk of anesthesia, blood
loss and infection

22. VASA
PREVIA

23. MEANING:
The term vasa previa is derived from the Latin
word;
“vasa’’ :-means vessel
“previa’’ :- pre- before
Via- way
so vasa previa means vessels lie before the
baby in the birth canal and in the way.

24. • The term vasa previa is used when a fetal
blood vessel lies over the os, in front of the
presenting part.
• This occurs when fetal vessels from a
velamentous insertion of the cord or to a
succenturiate lobe cross the area of the
internal os to the placenta.

26. DIAGNOSIS:
• Color-flow Doppler(TVS)
• Vaginal bleeding is often associated with
fetal distress(trachycardia, sinusoidal FHR
tracing)

27. MANAGEMENT
• Management depends on
Fetal
gestational
age
Severity of
bleeding
Persistence
or
recurrence
of bleeding
Availabilities
of
appropriate
neonatal
care facilities

28. A Patient with
confirmed vasa
previa
-Needs antenatal admission at 28-32weeks
of gestation
-Antenatal corticosteroids should be given
for fetal lungs maturity
B Any case with
bleeding vasa
previa
-Delivery should be done by emergency
cesarean section
-Intrapartum diagnosis of vasa previa, needs
expeditious delivery
C A case of confirmed
vasa previa
-At term (≥ 37weeks) should be delivered by
elective cesarean section prior to onset of
labor
D Neonatal blood
transfusion