Chord Prolapse

Question 1

What is chord prolapse?

Answer 1

Descent of umbilical cord through the cervix presenting part in the presence of ruptured membranes – OB EMERGENCY

Question 2

What is the aetiology of chord prolapse?

Answer 2

Potential space (unengaged presenting part ) allows descent of cord past the presenting part.

Question 3

What are the RFs of chord prolapse?

Answer 3

Breech, abnormal lie, multiple pregnancy, prematurity, low BW, unengaged presenting part, polyhydramnios, ARM.

Question 4

What is the epidemiology of chord prolapse?

Answer 4

0.1-0.6%

Question 5

What are the Hx and Exam findings in chord prolapse?

Answer 5

Abnormal FHR detected, often at membrane rupture

Cord felt or seen through cervix before presenting part

Question 6

What is the pathology of chord prolapse?

Answer 6

Compression of cord by presenting part and arterial spasm prevents blood flow through the cord, causing asphyxia.

Question 7

What is the management of chord prolapse?

Answer 7

Place patient on trendelemberg or knee-chest position.

Manually elevate presenting part (bladder filling)

Emergency delivery necessary, C section. Neonatal team present at delivery.

Question 8

What are the complications/ prognosis of chord prolapse?

Answer 8

HIE, fetal death. Perinatal mortality 9%. Higher if outside hospital.