Umbilical cord prolapse

Question 1

Define umbilical cord prolapse.

Answer 1

Umbilical cord prolapse involves the umbilical cord descending ahead of the presenting part of the fetus

Question 2

How common is umbilical cord prolapse?

Answer 2

1 in 500

Question 3

What are the complications of untreated umbilical cord prolapse?

Answer 3

Compression or cord spasm (in cold or if touched)

–> fetal hypoxia –> irreversible damage or death

Question 4

What are the risk factors for umbilical cord prolase?

Answer 4

Maternal:

• multiparity
• cephalopelvic disproportion
• AROM (50% occur with artifical rupture of membrances)

Fetal:

• prematurity
• twin pregnancy
• abnormal presentations e.g. Breech, transverse lie

Uterine/placental:

• polyhydramnios

Question 6

How is umbilical cord prolapse diagnosed?

Answer 6

Usually happens at AROM

FHR becomes abnormal

Cord is palpable vaginally, or is visible beyond the level of the introitus.

Question 7

What is the management of umbilical cord prolapse?

Answer 7

Disgnose by speculum/digital examination and confirmation of fetal viability by auscultation of the fetal heart using CTG

Press emergency call button - senior help and prepare theatres

• The patient is asked to go on ‘all fours’ until preparations for an immediate caesarian section have been carried out
• The left lateral position is an alternative
• Retrofilling the bladder with 500-700ml of saline may be helpful as it gently elevates the presenting part

Tocolytics may be used to reduce uterine contractions

Delivery by emergency caesarean section

Question 8

What can and what cannot be pushed back into the uterus in umbilical cord prolapse?

Answer 8

Presenting part of the fetus may be pushed back

The cord should not be handled but kept ward - should not be pushed back into the uterus

Question 9

What should be done if the cord is past the level of the introitus?

Answer 9

Minimal handling + kept warm and moist

Question 10

How common is morbidity and mortality of the fetus in umbilical cord prolapse?

Answer 10

Reported as high as 25–50% of cases

Question 11

Which category of C section is done in umbilical cord prolapse?

Answer 11

Category 1 if pathological fetal heart pattern

OR category 2 if normal fetal heart pattern

Question 12

Why has incidence of umbilical cord prolapse been reduced?

Answer 12

Reduced by the increase in caesarian sections being used in breech presentations

Question 13

Give an example of a tocolytic which may be used in cord prolapse.

Answer 13

Terbutaline

Question 14

Is vaginal delivery possible in cord prolapse?

Answer 14

Immediate caesarean section is normally used, but instrumental vaginal delivery is appropriate if the cervix is fully dilated and the head is low.