Cord prolapse for undergraduate

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CORD PROLPSE
DR MANAL BEHERY Assistant Professor, Faculty of
Medicine, Zagazig University
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Definition

• Cord Presentation Cord in front of presenting
  part before the rupture of membranes
• Cord Prolapse Cord in front of
• presenting part after rupture of
• membranes

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Cord presentation vs. Cord prolapse
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Occult cord prolapse

• Cord lying alongside the presenting part
• Occult vs. presentation vs. prolapsed cord

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Incidence

• Primigravida 0.45
• Multigravida 0.66 (Risk ratio 23)
• Cephalic 0.3
• Frank breech 0.9
• Complete breech 5
• Footling 10
• Shoulder 15
• Contracted pelvis 4-6 times

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Causes

• Malpresentation - face, brow, breech and shoulder
• Prematurity
• Polyhydramnios
• Multiple pregnancy
• Long cord (90-100 cm)
• PROM
• CPD
• Obstetric interventions - Amniotomy, Intrauterine
  pressure catheter, scalp electrode, external
  cephalic version,

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Dangers

• Mortality rate as high as 50
• Hypoxia
• Spasm of vessels
• Operative trauma to suboxgenated fetus

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Diagnosis

• Cord pulsations
• CTG shows
• variable decelerations
• Fundal pressure
• causes bradycardia
• Meconium stained
• liquor

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US cord loops Cord outside vulva
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Prevention

• Do US for malpresentation and cord presentation
• 2.FHR monitoring
• 3.Avoid ARM in an unengaged head
• 4.PV exam after ROM

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Management

• Lift presenting part off the cord
• Instruct patient NOT to push
• Position
• 1. Knee chest
• 2. Trendelenburg
• 3.Exaggerated position

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Knee chest position
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Trendelenburg position
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Exaggerated sims position
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Management (cont..)

• Vulval pad
• Replacement of cord
• Tocolysis (ritodrine)
• Funic Reduction
• Manual replacement of cord into uterus
• Cord gently pushed above presenting part while
  other cord decompression techniques are applied

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Stage II Labor

• - Expedite delivery with episiotomy and vacuum
  extraction or forceps
• Prepare for resuscitation of the newborn.

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Fetal Mortality
Fetal Mortality

• Overall - 50
• 1st stage of labour - 70
• 2nd stage of labour -30
• Neonatal death - 4
• Perinatal mortality- 20

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Fetal Mortality
Prognosis

• More with vertex than breech
• More with anterior than posterior.
• More in prime than multi
• lt 5 minutes, prognosis good, gt 5 mins, damage and
  death.

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THANK YOU