Umbilical Cord Prolapse &/or Presentation

Last updated 13.02.13

 

Index

 

 Definition

-  Cord Prolapse

-  Umbilical cord lies in front of or besides presenting part in presence of ruptured membranes

-  Cord Presentation

-  Umbilical cord lies between presenting part of foetus & cervix w intact membranes

 

 

Features

-  Incidence 0.2-.5% births

-  Higher in breech or multiple gestations (twins..)

-  Suspect in ARM or SROM if followed by bradycardia & severe variable decelerations on CTG

 

Risk Factors

-  High or illfitting presenting part

-  High parity

-  Mutiple gestations (twins..)

-  Polyhydramnios

-  Malpresentation: breech

-  Obstetric manipulation (ECV)

-  ARM with high presenting part or polyhydramnios

 

Ix

-  Visual inspection of vulva: cord prolapse

-  VE

-  Push off presenting part from cord

-  Cord prolapse palpated & feel for pulsation

-  Assess cervical dilation

-  DO NOT replace cord

-  CTG

 

Mx

-  Obstetric emergency

-  Immediate delivery if foetus viable

-  Position

-  Knee to chest position

-  OR Exaggerated Sims position

-  Aim to prevent cord compression

-  Push presenting part out of pelvis by fingers in vagina until delivery

-  +/- fill urinary bladder with fluid

-  Avoid overhandling of cord as may cause vasospasm

-  Ensure cord within vagina cold may also cause vasospasm

-  O2 to mother via face mask (preoxygenate for LUSCS)

-  Cease oxytocin

-  Expediated delivery

-  Code green immediate emergency LUSCS if vaginal birth not imminent

-  Assisted vaginal birth if suitable as per VE: fully dilated & multigravida

-  Allow labour & delivery if severe prematurity, fetal death or fetal anomaly inconsistent with life

-  Paired cord blood samples post delivery

 

 

 

 

 

References

 

RWH CPG incl Pics (Position): Labour: Cord Prolapse, 29/10/2011