Cord Prolapse
Cord prolapse = when the umbilical cord slips ahead of the presenting fetal part, leading to cord compression ➝ fetal hypoxia & bradycardia 🚨. It is a true obstetric emergency requiring rapid recognition and action.
📂 Types of Cord Prolapse
- 🔴 Overt: Cord visible at the introitus or palpable in the vagina (classic presentation).
- 🟠 Occult: Cord lies alongside presenting part, hidden — only suspected when FHR abnormalities appear.
⚠️ Risk Factors
- 👶 Multiple pregnancy
- 🌊 Polyhydramnios (excess amniotic fluid)
- 💧 PROM (esp. if head not engaged)
- ↔️ Malpresentation (breech, transverse lie)
- ⏳ Preterm labour
- 🤱 High parity (lax uterus/pelvis)
- 🩺 Amniotomy (especially artificial ROM with high head)
🔍 Diagnosis
- 👁️ Clinical exam: Cord seen at introitus or felt on vaginal exam.
- 📉 Fetal monitoring: Sudden prolonged/variable decelerations = red flag for cord compression.
- 🖥️ Ultrasound: Occasionally demonstrates cord beside presenting part.
🚑 Management (Emergency!)
- ✂️ Immediate delivery: Emergency caesarean section is the definitive treatment.
- ↗️ Maternal positioning: Knee–chest or steep Trendelenburg to relieve pressure on cord.
- ✋ Manual elevation: Push presenting part off the cord during transfer to theatre.
- 💨 Oxygen: Give high-flow O₂ to improve fetal oxygenation.
- 💊 Tocolysis: Consider (e.g., terbutaline) to reduce contractions if delay to delivery.
- ⚡ Do NOT attempt to push cord back inside vagina — keep it moist with warm saline swabs if protruding.
🚨 Complications
- 🧠 Fetal hypoxia/encephalopathy: Due to acute cord compression.
- ⚰️ Stillbirth: If prolonged hypoxia not reversed.
🛡️ Prevention
- ⛔ Avoid amniotomy if head not engaged.
- 🔎 Careful monitoring of malpresentation (consider elective C-section).
- 📉 Increased vigilance in polyhydramnios & multiple pregnancies.
📌 OSCE Pearls
- 💡 Cord prolapse = obstetric emergency — immediate C-section unless birth imminent vaginally.
- 💡 Always describe the maternal positioning + manual elevation step — a favourite OSCE point.
- 💡 Mention moist gauze on exposed cord to protect it.
- 💡 Know that FHR bradycardia/variable decels should trigger suspicion.
📚 References
