UMBILICAL CORD

PROLAPSE
Isharyah Sunarno

Definition
Cord prolapse : descent of the
umbilical cord through the
cervix alongside (occult) or
past the presenting part
(overt) in the presence of
ruptured membranes.

Definition
Cord presentation : the
presence of one or more loops
of umbilical cord between the
fetal presenting part and the
cervix, without membrane
rupture.

Background
Incidence : 0.1 - 0.6 %.
Breech presentation : > 1%.
The incidence is higher in multiple

gestations.
Cases of cord prolapse appear

consistently in perinatal mortality

enquiries ; perinatal mortality rate of
91 per 1000.

Background
Umbilical cord prolapse happens

when the umbilical cord precedes

the fetus' exit from the uterus.
Obstetric emergency during
pregnancy or labor
Imminently endangers the life of
the fetus.

rupture
of the
amnioti
c sac

puts
pressure
on the
cord

O22 &
blood
supplies
to the
fetus are
cut-of

fetus
moves
downwa
rd into
the
pelvis

cord
prolap
se

Brain
damage
/ death

Background
Asphyxia hypoxic-ischaemic

encephalopathy & cerebral palsy.

The principal causes of asphyxia :
cord compression preventing venous return

to the fetus and

umbilical arterial vasospasm secondary to

exposure to vaginal fluids and/or air.

Clinical areas

Risk factors for cord prolapse

Multiparity
LBW < 2.5 KG
Prematurity < 37 wks
Fetal congenital anomalies
Breech
Transverse, oblique &

unstable lie
Second twin
Polyhidramnios
Unengaged presenting
part
Low placenta, other
abnormal placentation
Fetus of male gender

Artificial rupture of

membranes
Vaginal manipulation of
the fetus with ruptured
membranes
External cephalic version
Internal podalic version
Stabilising induction of
labour
Applying fetal scalp
electrode (insertion of
uterine pressure
transducer

Amniotomy
Amniotomy increases the

production of, or causes a release

of, prostaglandins locally
Risks associated with this
procedure include umbilical cord
prolapse or compression,
maternal or neonatal infection,
FHR deceleration, bleeding from
placenta previa or low-lying
placenta, and possible fetal
injury.

Non Reassuring Fetal Heart Rate

ANTEPARTUM:
Umbilical cord prolapse
Umbilical cord compression
Uteroplacental insufficiency

Umbilical Cord Prolapse

Acute fetal bradycardia
Cord palpable in vagina
Membrane rupture with head not

well applied to cervix-High

station/breech presentation
Push presenting part away from
cervix
Emergency C/D

Umbilical Cord Compression

Variable decelerations
Nonreassuring if slow return to baseline

or severe (<60 bpm from baseline for

over 60 seconds) and repetitive
May be associated with amniotic fluid
from ruptured membranes or
oligohydramnios
Changing maternal position, oxygen,
amnioinfusion, discontinuation of
oxytocin may help
Expeditious delivery may be necessary

MANAGEMENT

 Reduce pressure on the cord &

deliver vaginally right away.

Emergency caesarean section
Trendelenburg position / kneeelbow position & an attendant
reaches into the vagina and
pushes the presenting part out of
the pelvic inlet and back into the
pelvis to remove the pressure
from the umbilical cord.

Thank
You