CORD PROLAPSE

Presented To: Presented By:

Department of Gynaecology Group C
& Obstetrics Subgroup A
Neema Jayswal
Nirajan Mahara
Pankaj Chaudhary
CONTENT
DEFINITION
CLINICAL TYPES
INCIDENCE
ETIOLOGY
EFFECT OF CORD PROLAPSE
DIAGNOSIS
PROGNOSIS
EARLY DETECTION AND ANTICIPATION
MANAGEMENT
DEFINITION
It is defined as the abnormal descend of umbilical cord alongside the presenting part or past
the presenting part in the presence or absence of ruptured membrane.
CLINICAL TYPES
Occult Prolapse
The cord is placed by the side of the presenting part
Not felt on PV examination
It could be seen on ultrasonography or cesarean section

Cord Presentation
Cord is slipped down below the presenting part
Bag of membrane is intact

Cord Prolapse
The cord is lying inside the vagina or outside the vulva
Bag of membrane is ruptured
INCIDENCE
1 in 300 deliveries
Mostly confined to parous woman
Incidence is reduced due to increased use of elective CS in noncephalic presentation
 ETIOLOGY
Anything which interferes with perfect adaptation of the presenting part to the lower uterine segment, disturbing the ball
valve action may favor cord prolapse.
(1) Malpresentations:
-most common being Transverse lie(5-10%), Breach presentation(3%), Compound presentation(10%)
- Oblique lie, Unstable lie, high presenting part
(2) Contracted pelvis
(3) Prematurity
(4) Second twin
(5) Hydramnios
(6) Placental factor – minor degree of placenta previa
(7) Iatrogenic – manual rotation of head, AROM, ECV, IPV
(8) Stablizing induction of labor
EFFECT OF CORD PROLAPSE
Cord prolapse

Hypoxia to baby

Mechanical compression by presenting part Vasospasm of umbilical vessel

Due to exposure to cold or irritation when exposed outside vulva or as a result of handelling
 DIAGNOSIS
1. Occult Prolapse:
•Difficult to diagnose since cannot be palpated on PV examination
•Possibility should be suspected if clinical features of fetal bradycardia or prolonged fetal heart rate deceleration detected on
continuous electronic fetal monitoring
•Confirmation is by transvaginal sonography or during CS
2. Cord Presentation:
•On PV examination pulsation of cord is felt through intact membrane
3. Cord Prolapse
•On PV examination cord is palpated by the finger as the membrane is absent
•And its pulsation can be felt if the fetus is alive
•Cord pulsation may cease during uterine contraction which however returns after the contraction passess off
•Temptation to pull down the loop for visualization or unnecessary handling is to be avoided to prevent vasospasm
 PROGNOSIS
Fetal:
oThe hazards to the fetus is more in vertex presentation especially when the cord is prolapsed through the
anterior segment of the pelvis or when the cervix is partially dilated
oThe prognosis is, however, related with the interval between its detection and delivery of the baby and if
the delivery is completed, within 10–30 minutes the fetal mortality can be reduced to 5–10%.
oThe overall perinatal mortality is about 15–50%

Maternal:
oThe maternal risks are incidental due to emergency operative delivery, especially through the vaginal route.
oOperative delivery involves the risk of anesthesia, blood loss and infection
EARLY DETECTION AND
ANTICIPATION
1. Internal examination should be done
•In PROM
•During labor in all cases of malpresentation, twins, hydramnios or vertex presentation where the
head is not engaged

2. Surgical induction should preferably be conducted in the operation theater keeping everything
ready for cesarean section, if the head is not engaged prior to low rupture of the membranes.
Internal examination both before and after amniotomy should be carried out with cord accident in
mind.

3. Exclusion of cord presentation or occult prolapse, in unexplained fetal distress during labor
MANAGEMENT
In Cord Presentation
Aim is to preserve the membranes and to expedite the delivery
If immediate vaginal delivery is not possible or contraindicated, cesarean section is the
best method of delivery
Once the diagnosis is made, no attempt should be made to replace the cord, as it is not
only ineffective but the membranes inevitably rupture leading to prolapse of the cord
A rare occasion is a multipara with longitudinal lie having good uterine contractions
with the cervix 7–8 cm dilated, without any evidence of fetal distress. Watchful
expectancy can be adopted till full dilatation of the cervix, when the delivery can be
completed by forceps or breech extraction.
First Aid Management
Aim: Minimize pressure on the cord
1. Manual relief by pushing the presenting part
2. Retrograde Bladder filling
3. Positional treatment – Knee chest ; Trendelenburg ; Exaggerated and elevated Sims position
 YO U
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