UMBILICAL

CORD
PROLAPSE
Professor
Department of Obstetrics & Gynecology
King Khalid University
Abha, Saudi Arabia

To

provide information and practical

guidance to
enable early diagnosis and efficient initiation of
emergency procedures to ensure the best
possible neonatal outcome

Umbilical cord presentation: Presence of

cord in front of presenting part before the
rupture of membranes.

Umbilical cord prolapse: Descent of

umbilical cord following rupture of the
membranes, through the cervix so that it lies
either along side the fetal part or in front of
presenting part into the cervix/ and into or
out of vagina.

 Occult

prolapse - Cord lies adjacent to the

presenting part, but not beyond the
presenting part in the presence of intact or
without intact membranes.

Overt

prolapse - cord which is visible or

palpable with naked eyes following rupture
of membranes.

Identify predisposing risk factors

Enable prompt diagnosis and institute
immediate action
Initiate correct emergency procedures
Raise awareness of the neonatal implications

 Over

all incidence - 0.1% -0.6%

Primi gravida - 0.4 %
Multi gravida - 0.6 %
Cephalic presentation - 0.3 %
Breech - Frank - 0.9 %
- Complete - 5 %
- Footling - 10 %
Shoulder presentation - 15 %
Contracted pelvis - 4-6 times more.

 Non

engagement of fetal head:

1.Unengaged or poorly applied presenting part
2. High parity - weak muscles 3.
Unstable lie - weak muscles
4. Malpresentations
5. Breech presentations

Related to Uterine and Pelvic factors:

1. Polyhydramnios
2. Long umbilical cord 3.
Low lying placenta
4. Contracted Pelvis

Related to Fetal factors:

1. Prematurity
2. Low Birth Weight
3. Second twin
4. Congenital malformations

Related to clinical procedures:

1. ARM in high presenting part
2. External cephalic version
3. Stabilizing induction of labor
4. Manual rotation of fetal head in OP position
5. Application of fetal scalp electrode
6. Internal podalic version of second twin

 Other

causes

1. PROM
2. Male fetuses
3. Anomalies of uterus

Neonatal morbidity and Mortality - as high

as 50 % due to
1. Hypoxia - is due to cord compression by
the presenting part and also due to
vasospasm of umbilical vessels
2. Operative trauma 3.
Delay in transport
4. Congenital malformations
5. Prematurity
Maternal morbidity :

Overt cord can be seen in the vagina or

outside the vagina- feel pulsations
Variable deceleration and bradycardia on
CTG following rupture of membranes.
Fetal bradycardia - following fundal pressure
Meconium stained liquor

Ultrasound examination for malpresentation

and cord presentation.
Avoid ARM in unengaged head
Routinely doing PVE following spontaneous
rupture of membranes.
Controlled ARM in poly hydramnios Stabilizing induction.
Bradycardia and variable decelerations - do
either vaginal examination or speculum
examination

 Depends

upon viability of the fetus and

absence of fetal malformations.
Quick action should be taken to expedite the
delivery.
Survival of fetus depends on swift action
Prepare for Emergency interventions like
Cesarean section and or Instrumental
delivery.
Multidisciplinary approach or Team work is
required

Discontinue IV oxytocin infusion

Oxygen
CORD

by mask - 15 lits/ mt

- C - call for help

- O - organize for delivery
- R - Relieve pressure
- D - Delivery
Funic repositioning: with soaked warm saline
reposition into vagina

 Avoid

presenting part pressure over cord by

digital or manual pressure.
Instruct the patient to not to exert pressure
or pushing.
Bladder filling with 500 700 ml of saline.
Tocolysis? Inj.Terbutaline 250 microgams SCly
Positioning of the patient:
1. Knee chest position
2. Trendelenburg position
3. Exaggerated Sims or lateral position

Do's Replace the cord into the vagina to prevent

from vasospasm with saline soaked pad
Continuous monitoring of FHR
Inform the patient
Minimal handling of cord
Don'ts Replace inside the uterus
Excessive handling of the cord.

 Knee

chest face down position

Bladder filling with saline
In Ambulance - left lateral position
Manual elevation - if a nurse or family
physician there
Urgent transfer to center with cesarean
facilities and neonatal care.

 Stage

I of

Labor
Prepare for Emergency Cesarean section
Inform the senior pediatrician
Delivery should be done within 30 minutes
If fetal death occurs, try for vaginal delivery.
Stage II Labor:
Expedite delivery with liberal episiotomy and
instrumental delivery.
If there is fetal heart disturbance and not in
favor of vaginal delivery plan for Emergency

Cesarean section.

Extreme prematurity with cord prolapse:

1. Below or around 24 weeks - counsel the
patient.

If she wishes to continue pregnancy if FHR is

normal and patient willing for up to 3 weeks
If patient does not agree allow for vaginal
delivery with or without oxytocin infusion

Overall - 50 %
First stage of labor - 75 %
Second stage - 50 %
Neonatal death - 4 %
Perinatal mortality - 20 %
Asphyxia - Hypoxic ischaemic encaephlopathy
- Cerebral palsy

 Good

with vertex presentation

than Breech.
Good in Primigravida than in multi.

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Thank You