Cord prolapse (Complete) Flashcards
Define cord prolapse?
Complication during labour in which the umbilical cord exits the cervix before foetal head resulting in compression and comprimised circulation.
What are the main risk factors for cord prolapse?
Foetal factors: (Anything which increases space for cord slippage)
Abnormal lie (e.g. transverse or breech)
Prematurity
Low birth weight
High foetal head at delivery (poor engagement)
Maternal factors:
Multiparity
- Reduced uterine and abdominal tone leading to poor engagement
Multiple pregnancy
- Higher risk of abnormal lie
Polyhdraminos
- Excess fluid increases foetal mobility and sudden changes in position of cord
What are the main clinical features of cord prolapse?
Sudden change in foetal HR patterns
- Variable or prolonged declerations
Feeling of or visible cord in vagina after rupture of membranes
What differentials should be considered alongside cord prolapse?
Vasa praevia (bradycardia + ROM)
- Painless vaginal bleeding
- No palpable cord
Uterine rupture (foetal HR changes)
- Severe abdominal pain
- Maternal shock
Placental abruption (foetal distress)
- Painful vaginal bleeding
- Uterine tenderness
What investigations should be considered in patients with suspected cord prolapse?
Bedside:
CTG: Check for variable or prolonded decelerations
Vaginal examination: Confirm presence of cord in birth canal
What is the management plan for cord prolapse?
1) Call for help
2) Prevent further cord compression
- Push back presenting part of foetus back into uterus
- Retrofilling the bladder with warm saline
- Avoid handling the cord (triggers vasopasm)
- Consider administration of tocolytics
3) Position the mother
- All fours position
- Knee to chest position
- Lateral position
4) Delivery ASAP (whichever is quicker)
- Emergency C-section
OR - Expedited vaginal delivery
How should mothers be positioned during cord prolapse?
Any of the following:
All fours
Knee to chest position
Left lateral positioning
What foetal complications can occur due to cord prolapse?
Foetal death
Hypoxic ischaemic encephalopathy
Birth injuries
What maternal complications can occur due to cord prolapse?
Urgent C-section
Increased maternal morbidity
