Cord Prolapse Flashcards
Define cord prolapse and its types
Umbilical cord descends through the cervix, with (or before) the presenting part of the fetus
Occult (incomplete) = cord descends alongside the presenting part, but not beyond it
Overt (complete) = cord descends past the presenting part and is lower than the presenting part in the pelvis
Cord presentation = the presence of the umbilical cord between the presenting part and the cervix. This can occur with or without intact membranes.
Why does hypoxia occur secondary to cord prolapse?
Occlusion = the presenting part of the fetus presses onto the umbilical cord, occluding blood flow to the fetus
Arterial vasospasm = the exposure of the umbilical cord to the cold atmosphere results in umbilical arterial vasospasm, reducing blood flow to the fetus
What are the main risk factors for cord prolapse?
Breech presentation = in a footling breech, the cord can easily slip between and past the fetal feet and into the pelvis
Unstable lie = this is where the presentation of the fetus changes between transverse/oblique/breech and back
Artificial rupture of membranes = particularly when the presenting part of the fetus is high in the pelvis
Polyhydramnios = excessive amniotic fluid around the fetus
Prematurity
What are the clinical features of an UCP?
Fetal HR problem - bradycardia
Absent membranes
How should UCP be managed?
Avoid handling cord - reduce vasospasm
Manually elevate the presenting part
L lateral position
Tocolysis (terbutaline) - relaxes the uterus to stop contractions
Delivery via CS
