CORD PRESENTATION/ CORD PROLAPSE Anupama Tamrakar Lecturer, Yenepoya Nursing College

Definitions Cord presentation: a condition in which the umbilical cord is in front of the presenting part of the fetus with the membranes intact(not ruptured). Cord prolapse: this is a condition in which the umbilical cord is in front of the presenting part of the fetus with the membranes ruptured.

types Occult prolapse: the prolapsed cord is contained within the uterus usually by the side of the presenting part unnoticed Overt prolapse: the cord protrude into the vagina

Overt Prolapse

Incidence Incidence of cord prolapse is 1 in 300 deliveries More in multigravidae Etiology: Anything that interfers with the perfect adaptation of the presenting part to the lower ut segment and disturbing ball valve action may favour cord prolapse.

Predisposing factors

Contd..

Diagnosis Difficult to diagnose Suspect if persistence of variable deceleration of fetal heart rate pattern Cord presentation: feeling of pulsation of the cord through the intact membranes Cord prolapse: cord palpated by fingers and pulsation if fetus is alive

Consequence of UCP The cord is often compressed by either the shoulder, breech or head . A fetal heart rate pattern that suggest hypoxaemia (eg severe bradycardia, severe variable accelerations) may be the clue especially in occult prolapse.

Prevention of cord prolapse High index of suspicion of cord presentation Care when performing artificial rupture of fetal membranes Careful monitoring of FHR to detect irregular heart rate pattern that may suggest cord compression (severe bradycardia, severe variable accelerations

Management diagnosed early , or perhaps even prevented . Risk factors such as malpresentation, polyhydramnios, a high presenting part or a structural anomaly should alert possibility of cord prolapse.

Contd.. Avoidance of ARM in cases of cord presentation would prevent cord prolapse Making sure that there is no cord presentation before membranes rupture Rupturing membranes gradually and guiding the draining of flow - it avoid sudden decompression

METHODS OF ALLEVIATION OF PRESSURE ON THE PROLAPSED CORD Alleviation of pressure on the prolapsed cord until delivery can be achieved through by : Digital disengagement of the presenting part Raising the maternal pelvis (Tredelenburgs position or sim’s position) Filling of the maternal bladder

DELIVERY if the cervix is not fully dilated, prompt delivery through emergency caesarean section offers the best chance of favourable fetal outcome. If the fetus is dead, then manage labour as indicated

Complications of cord prolapse Fetal distress Intrapartum fetal death Neonatal asphyxia Early neonatal death