1. CORD PRESENTATION AND PROLAPSE

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

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

5. 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.

6. 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

7. 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

8. 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.

9. 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