2. Cord Prolapse
โฆ When part of cord falls in front of presenting
part
โฆ Membrane ruptured
โฆ Incidence:
0.2-0.4% in vertex
0.5% in frank (extended) breech 4-6%
in complete (flexed) breech 15-18% in
footling breech
3. PREDISPOSING FACTORS
โฆ Fetal
โ Prematurity
โ Multiple gestation
โ Anencephaly
โ Malpresentation
โข Breech
โข Transverse lie
โข Oblique
โฆ Liquor
โ Polyhydramnios -
especially when PROM
โฆ Mother
โ Multiparity
โ Contracted pelvis (CPD)
โ Pelvic tumours
โฆ Placenta & cord
โ P. praevia
โ Long cord
โ Rupture of membranes
โฆ Iatrogenic prolapse
โ ARM
โ Version
โ Placement of forceps or a
scalp electrode*
โ Obtaining fetal scalp blood
for pH*
4. DIAGNOSIS
โฆ Appearance of loop of umbilical cord
โฆ Pulsation of cord on V/E
โฆ Suspect in unexplained fetal distress
โ Variable decelerations
โ Prolonged bradycardia
5. MANAGEMENT
โฆ Is baby viable?
โ IUD - Aim for vaginal delivery
โ Alive - aim for most expedient delivery method
โข Instrumental delivery โ if os full and expecting a
relatively easy and fast delivery
โข Otherwise crash Caesarean section
6. โฆ Relieve cord compression
โ Replace cord gently into vagina
โ Place hand in vagina, cord cradled in palm
โ Tips of fingers elevating presenting part
โ Mother in trendelenburg or knee-chest position
โ Fill bladder (16 Foley catheter, 500-800ml of saline)
7. โฆ Continuation of relieving of cord
compression during
โ Induction of anaesthesia
โ Placement of sterile sheet
โ LSCS
โฆ Remove hands only when the surgeon tells
you!