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

2. 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.

4. 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

6. Overt Prolapse

8. 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.

9. Predisposing factors

10. Contd..

11. 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

12. 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.

13. 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

14. 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.

15. 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

16. 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

18. 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

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