CORD PRESENTATION AND PROLAPSE

DEFINITION Umbilical cord prolapse is a condition in which the umbilical cord descends alongside or below the presenting part.

Etiology Improper fitting of the presenting part into the maternal pelvis Malpresentation Contracted pelvis Prematurity Twins Hydramnios Placental factor Iatrogenic

Clinical types Overt cord prolapse The cord lies inside the vagina or outside the vulva following rupture of the membranes. It is the most common type. Cord (funic) presentation The cord is slipped down below the presenting part and is felt lying in the intact bag of membranes. The umbilical cord can be palpated on vaginal examination. Occult cord prolapse The cord is placed by the side of the presenting part and is not felt by the fingers on internal examination.It can occur with intact or ruptured membranes.

Diagnosis Overt cord prolapse palpated by the fingers as the membranes are absent pulsation can be felt if the fetus is alive. Cord presentation feeling the pulsation of the cord through the intact membranes. Occult cord prolapse It is difficult to diagnose clinical features of fetal bradycardia or prolonged foetal heart rate deceleration confirmation is by transvaginal sonography

Anticipation and early detection Internal examination when the case presents premature rupture of membranes Malpresentation Twins hydramnios non engaged vertex presentation. Surgical induction in the OT. Uterine contractions initiated by oxytocin if the head is not engaged prior to Exclude cord presentation or occult prolapse in unexplained fetal distress during labour

Management CORD PRESENTATION Aims to preserve the membranes and to expedite the delivery: No attempt should be made to repalce the cord. If immediate vaginal delivery is not possible or contraindicated, LSCS is the best A rare occasion is a multipara with longitudinal lie having good uterine contractions with the cervix ¾ dilated, without any evidence of fetal distress. Watchful expectancy can be adopted till full dilatation of the cervix, when the delivery can be completed by forceps or breech extraction.

Management of CORD PROLAPSE Baby live/dead Maturity of baby Cervical dilatation Baby alive Baby dead -Confirm with USG Immediate vaginal delivery Immediate safe vaginal -W/F spontaneous labor not possible/contraindicated delivery -Destructive operation Vertex Breech Forceps or Ventouse Breech extraction First Aid Definitive Management Bladder Filling - Caesarean Section Lift the presenting part off the cord Postural treatment Replace cord into the vagina