CORD PROLAPSE

There are three clinical types of decent of Cord

A. Occult prolapseThe cord is placed by the side of the presenting part and is not felt
by fingers on internal examination
B. Cord presentationThe cord has slipped below the presenting part and is felt lying in
the intact bag
of membranes
C. Cord prolapseThe cord is lying inside or outside the vagina following rupture of
membranes
Incidence of Cord Prolapse : 1:500 Deliveries
Risk Factors :
Maternal
- Pelvic tumors ( Fibroids )
- Narrow Pelvis
- Premature rupture of membranes,
- Grand multiparity (more than 5
pregnancies)
- Multiple Pregnancies

Fetal Causes
Prematurity
Mal Presentation
Breech Presentation
Transverse Lie
Multiple Pregnancy
Polyhydrominos
Placenta Previa
Large Baby

Diagnosis
Diagnosis is made clinically by seeing the cord at introitus or feeling it.
Perinataly : Abnormal Fetal Heart sounds due to compression of umbilical vein between
the presenting part and the pelvis
Management :
Once prolapse of the cord has occurred urgent action is needed.
Immediate pelvic examination is to be done to find dilatation and effacement of
cervix:
- To relieve pressure on the cord.
- To find out if the foetus is alive or dead, strength of pulsations of the cord. Repeated
cord palpation for pulsation also induces spasm hence, listening to foetal heart is a
better alternative.
- To expedite delivery, if alive.
- To await spontaneous delivery if dead and the pelvis and presentation are favourable.
In cord prolapse:
First look for:
- viability of the foetus
- maturity of the foetus
- associated complicating factors
- dilatation of the cervix.
If the Foetus is Alive
Immediate vaginal delivery not possible or contraindicated
First aid is to minimise pressure on cord as long as the patient can be transferred or
prepared for

assisted delivery. Give oxygen to the mother:

- To lift the presenting part off the cord by the gloved fingers into the vagina and keep
there till definitive treatment can be done. Amnioinfusion may be done in an attempt to
decrease pressure on umbilical cord.
- Keep the patient in exaggerated elevated Sims position with pillow under the
buttocks.
- The end of bed may be elevated. High Trendelenburg and knee-chest position
traditionally mentioned is very tiring and irksome to the patient but may be tried
Definitive treatment
- Caesarean section when the baby is sufficiently mature enough to survive and the
cervix is not fully dilated.
If Foetus Dead
Labour is allowed to continue awaiting spontaneous delivery. Sometimes destructive
operation may be required.
Prognosis :
The foetal prognosis depends on the following factors:
Duration of cord compression : If longer than 10 minutes it will cause
cerebral damage , If around 20 minutes Fetal death.
- Status of membranescord presentation (membranes intact) has 100 per cent
survival rate for thefoetus, if diagnosed in time.
- Foetal reserve IUGR
- Stage of labour : The risk is less when the cord is prolapsed in the second stage
(30%) than when it prolapses in the first stage (70%).
- Foetal presentationThe dangers are greater in vertex than breech presentation.
Maternal :
Maternal morbidityis also increased as a consequence of operative delivery with
associated risk of anaesthesia, blood transfusion, infection and the direct trauma of
instruments