Obs Emergency: Cord Prolapse

Question 1

Define cord prolapse.

Answer 1

Descent of the umbilical cord through the cervix alongside (occult) / past presenting part (overt) in the presence of ruptured membranes.

Question 2

Risk factors.
FETUS (6)

Answer 2

1) Prem/ LBW
2) Multiple pregnancies
3) fetal anomaly- anencephaly
4) malpresentation
5) Unengaged presenting part
6) Abnormal lie
- transverse
-oblique
- Unstable lie

Question 3

RF.

Maternal (5)

Answer 3

1) multiparity
2) Pelvic tumor
3) Contracted pelvis
4) Polyhydramnios
5) PROM

Question 4

RF.

Iatrogenic (5)

Answer 4

1) ARM w/ high station of presenting part
2) ECV
3) Internal podalic version
4) placement of fetal scalp electrode
5) Cervical ripening balloon (large balloon catheter)

Question 5

How to Dx.? (3)

Answer 5

• Pulsating tubular structure felt during VE
• Loop of cord seen outside vagina
• Abnormal FHR soon after membrane rupture

Question 6

Early assessment (6)

Answer 6

1) Immediate assessment :VE: Cervical dilatation/ station/ Presenting part
2) Check FHR/ fetus alive?
3) Call for help: O&G specialist, MO, midwives, paeds
4) Cont. CTG
5) Secure IV cannula
6) Do not manipulate cord

Question 7

If imminent delivery:
what is the management? (4)

Answer 7

1) Drain bladder
2) Expedite delivery
3) Vaginal delivery: if FHR reassuring
4) Prepare instrumental delivery/ C-sec

Question 8

If non-imminent delivery:
Management? (7)

If fetus is viable.

Answer 8

1) Elevate presenting part (2 pillows buttocks)
2) 2 fingers vagina; elevate PP
3) Inflate bladder with NS
4) Arrange for category 1 C-sec
5) Empty bladder upon C-sec
6) Assistant withdraw hands after delivery of baby

Question 9

If non-imminent delivery:
Management? (1)

If fetus is non-viable.

Answer 9

Aim vaginal delivery if fetus in longitudinal position

Then continue with active management of 3rd stage