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UMBILICAL CORD

PROLAPSE
Isharyah Sunarno

Definition
Cord prolapse : descent of the
umbilical cord through the cervix

alongside (occult) or past the


presenting part (overt) in the

presence of ruptured membranes.

Definition
Cord presentation : the presence of
one or more loops of umbilical cord

between the fetal presenting part


and the cervix, without membrane
rupture.

Background
Incidence : 0.1 - 0.6 %.
Breech presentation : > 1%.
The incidence is higher in multiple gestations.
Cases of cord prolapse appear consistently in

perinatal mortality enquiries ; perinatal

mortality rate of 91 per 1000.

Background
Umbilical cord prolapse happens when

the umbilical cord precedes the fetus'


exit from the uterus.
Obstetric emergency during pregnancy
or labor
Imminently endangers the life of the
fetus.

rupture
of the
amniotic
sac

puts
pressure
on the
cord

O2 &
blood
supplies
to the
fetus are
cut-off

fetus
moves
downwar
d into the
pelvis

cord
prolaps
e

Brain
damage /
death

Background
Asphyxia hypoxic-ischaemic

encephalopathy & cerebral palsy.


The principal causes of asphyxia :
cord compression preventing venous return to the

fetus and
umbilical arterial vasospasm secondary to

exposure to vaginal fluids and/or air.

Clinical areas

Risk factors for cord prolapse

Multiparity
LBW < 2.5 KG
Prematurity < 37 wks
Fetal congenital anomalies
Breech
Transverse, oblique &
unstable lie
Second twin
Polyhidramnios
Unengaged presenting part
Low placenta, other
abnormal placentation
Fetus of male gender

Artificial rupture of

membranes
Vaginal manipulation of the
fetus with ruptured
membranes
External cephalic version
Internal podalic version
Stabilising induction of
labour
Applying fetal scalp
electrode (insertion of
uterine pressure
transducer

Amniotomy
Amniotomy increases the production of,

or causes a release of, prostaglandins


locally
Risks associated with this procedure
include umbilical cord prolapse or
compression, maternal or neonatal
infection, FHR deceleration, bleeding
from placenta previa or low-lying
placenta, and possible fetal injury.

Non Reassuring Fetal Heart Rate


ANTEPARTUM:
Umbilical cord prolapse
Umbilical cord compression
Uteroplacental insufficiency

Umbilical Cord Prolapse


Acute fetal bradycardia

Cord palpable in vagina


Membrane rupture with head not well

applied to cervix-High station/breech


presentation
Push presenting part away from cervix
Emergency C/D

Umbilical Cord Compression


Variable decelerations

Nonreassuring if slow return to baseline or

severe (<60 bpm from baseline for over 60


seconds) and repetitive
May be associated with amniotic fluid from
ruptured membranes or oligohydramnios
Changing maternal position, oxygen,
amnioinfusion, discontinuation of oxytocin
may help
Expeditious delivery may be necessary

MANAGEMENT

Reduce pressure on the cord & deliver

vaginally right away.


Emergency caesarean section
Trendelenburg position / knee-elbow
position & an attendant reaches into the
vagina and pushes the presenting part
out of the pelvic inlet and back into the
pelvis to remove the pressure from the
umbilical cord.

Thank
You