Lucy Pettit, Midwife, Wanganui

1. Umbilical Cord
Prolapse
Lucy Pettit

2. Aims
Provide information and practical guidance to
enable early diagnosis and efficient initiation of
emergency procedures to ensure the best possible
neonatal outcome

3. Definition
 Overt prolase, the more common of the two,
involves protrusion of the umbilical cord past the
presenting part and into or out of the vagina

4. Definition
 Occult prolapse, on the other hand, occurs when
the cord descends alongside but not past the fetal
presenting part; it's not always palpable on digital
examination. Occult prolapse can occur even
when fetal membranes remain intact.

5. Objectives
 Identify predisposing risk factors
 Enable prompt diagnosis and institute
immediate action
 Initiate correct emergency procedures
 Raise awareness of the neonatal
implications

6. Predisposing factors
 Multiple pregnancy
 High presenting part
 Polyhydramnios
 Premature labour
 Malpresentations
 Fetal abnormalities
 Uterine abnormalities

7. Management
 Fetal survival depends on swift action
 Call for help – midwifery colleagues/8000
 Factors to consider:
 Viability
of fetus
 Severe fetal abnormalities
 Emergency delivery for a normally formed
and mature fetus

8. First stage of labour
 Emergency LSCS
 Take measures to optimise fetal well-being
(maternal positioning)
 Multidisciplinary approach
 Teamwork

9. Second stage of labour
 Vaginal delivery
 Depends on descent of head & rate of progress;
parity
 Instrumental delivery
 Depends on skill levels & confidence; descent of head
& rate of progress.
 Not a midwifery decision
 Caesarean section
 Take measure to ensure to optimise fetal well-being
 Multidisciplinary approach
 Teamwork

10. Emergency procedures
 Elevation of the presenting part:
 Digital pressure
 Kneeling on all fours, buttocks uppermost, or
 Exaggerated Sims (left lateral)
 Fill bladder with 500mls saline
 Tocolysis

11. Do’s & Don'ts
DO DON’T
 Replace the cord  Replace the cord
into the vagina inside the uterus
 Monitor the fetal  Handle the cord
HR excessively
 Inform the woman

12. Mnemonic
Call for help
Organise delivery
Relieve pressure on the cord
Deliver

13. Emergency Checklist
Em ergency Checklist
Cord Present at ion/ Pr olapse Bradma
Procedure Dat e_____________ Tim es Nam es of
pr act it ioner s
pr esent
• Emergency Bell …………….
• 8000 obstetric emergency call made …………….
• EXAMINER performing VE protects cord from compression by …………….
remaining in position
• Woman moved to knee/chest or exaggerated left lateral …………….
position
• Check fetal heart rate and assess uterine activity …………….
• Commence maternal oxygen …………….
• Notify theatre of need for immediate caesarean section …………….
• Ensure Paediatrician attends main theatre …………….
• Move woman to theatre on delivery bed …………….
• Documentation …………….
Photocopy this checklist and place in patient’s notes with patient label on top of page. Use as
reference for more detailed clinical notes. Remember to sign the copy for the clinical notes
Please wipe clean checklist once copied and return to delivery room
…………….