Cord Prolapse

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Umbilical cord prolapse\: umbilical cord descends below fetal presenting part through cervix with ruptured membranes.
Obstetric emergency\: can lead to fetal hypoxia if untreated.
Aetiology\: factors increasing risk include fetal malposition (breech, transverse, unstable lie), twin pregnancy (especially
second twin), polyhydramnios, arti
History\: clarify details of membrane rupture (timing, spontaneous/arti
Clinical
rate monitoring; less common
Investigations\: rarely required, diagnosis based on clinical
position if needed.
Management\:
Elevate fetal presenting part via vaginal examination to prevent cord pressure.
Avoid touching cord to prevent vasospasm.
Fill bladder with 500ml normal saline via catheter for fetal part elevation.
Maternal knee-chest position to reduce cord pressure.
Immediate delivery via caesarean section; category one caesarean if fetal heart rate abnormal (delivery within 30 minutes).
Complications\:
Birth hypoxia\: neonatology team present at delivery, paired umbilical cord gases to assess fetal pH.
Psychological trauma\: event explanation to mother after delivery.
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A comprehensive topic overview

Introduction

Umbilical cord prolapse is de
through the cervix, in the presence of ruptured membranes.
Cord prolapse is an obstetric emergency that can quickly lead to fetal hypoxia if left untreated.

Aetiology

The exact cause of cord prolapse varies in each pregnancy, however, generally any factors associated with fetal
malposition increase the risk as well as obstetric procedures, these can include\:
1
Breech, transverse, unstable lie
Twin pregnancy (especially delivery of the second twin)
Polyhydramnios
Arti
External cephalic versionClinical features
History
A history would typically involve clarifying\:
The details surrounding the rupture of membranes (e.g. timing, spontaneous or arti
Identi
Clinical examination
Typical clinical
2
Umbilical cord palpated on vaginal examination
Acute bradycardia/fetal distress (\<100 bpm) noted on fetal heart rate monitoring
Less common clinical
Umbilical cord visible (hanging outside the introitus)

Investigations

Investigations are rarely required as the diagnosis is based on clinical
2
If there is doubt regarding fetal heart rate measurement or fetal position, bedside ultrasound can be used to con

Management

Cord prolapse is an obstetric emergency as the umbilical cord will develop vasospasm and fetal hypoxia will occur if left
untreated.
Vaginal examination allows for con
pressure on the umbilical cord.
Care should be taken to avoid touching the cord as this will also cause vasospasm.
Filling the bladder can help with the elevation of the fetal presenting part, this can be achieved by inserting a catheter and

Maternal position can also help to reduce pressure on the umbilical cord, this is typically the knee-chest position (similar to
all fours but with pelvis higher than shoulders).
Immediate delivery is required by caesarean section. If the fetal heart rate pattern is abnormal, this should be a category
one caesarean section (delivery within 30 minutes).
1

Complications

Complications of cord prolapse include\:
Birth hypoxia\: neonatology team should be present at delivery and paired umbilical cord gases should be taken to
assess fetal pH
after delivery
Psychological trauma\: due to the emergency nature of cord prolapse, the event should be explained to the mother

References

Royal College of Gynaecologists. Umbilical Cord Prolapse. 2014. Available from\: [LINK]
Lawrence Impey & Tim Child. Obstetrics & Gynaecology. 2017.Related notes
Amniotic Fluid Embolism
Antenatal Screening for Down’s Syndrome
Antepartum Haemorrhage (APH)
Breech Presentation
Caesarean Section