Cord prolapse = when the umbilical cord slips ahead of the presenting fetal part, leading to cord compression β fetal hypoxia & bradycardia π¨. It is a true obstetric emergency requiring rapid recognition and action.
π Types of Cord Prolapse
- π΄ Overt: Cord visible at the introitus or palpable in the vagina (classic presentation).
- π Occult: Cord lies alongside presenting part, hidden β only suspected when FHR abnormalities appear.
β οΈ Risk Factors
- πΆ Multiple pregnancy
- π Polyhydramnios (excess amniotic fluid)
- π§ PROM (esp. if head not engaged)
- βοΈ Malpresentation (breech, transverse lie)
- β³ Preterm labour
- π€± High parity (lax uterus/pelvis)
- π©Ί Amniotomy (especially artificial ROM with high head)
π Diagnosis
- ποΈ Clinical exam: Cord seen at introitus or felt on vaginal exam.
- π Fetal monitoring: Sudden prolonged/variable decelerations = red flag for cord compression.
- π₯οΈ Ultrasound: Occasionally demonstrates cord beside presenting part.
π Management (Emergency!)
- βοΈ Immediate delivery: Emergency caesarean section is the definitive treatment.
- βοΈ Maternal positioning: Kneeβchest or steep Trendelenburg to relieve pressure on cord.
- β Manual elevation: Push presenting part off the cord during transfer to theatre.
- π¨ Oxygen: Give high-flow Oβ to improve fetal oxygenation.
- π Tocolysis: Consider (e.g., terbutaline) to reduce contractions if delay to delivery.
- β‘ Do NOT attempt to push cord back inside vagina β keep it moist with warm saline swabs if protruding.
π¨ Complications
- π§ Fetal hypoxia/encephalopathy: Due to acute cord compression.
- β°οΈ Stillbirth: If prolonged hypoxia not reversed.
π‘οΈ Prevention
- β Avoid amniotomy if head not engaged.
- π Careful monitoring of malpresentation (consider elective C-section).
- π Increased vigilance in polyhydramnios & multiple pregnancies.
π OSCE Pearls
- π‘ Cord prolapse = obstetric emergency β immediate C-section unless birth imminent vaginally.
- π‘ Always describe the maternal positioning + manual elevation step β a favourite OSCE point.
- π‘ Mention moist gauze on exposed cord to protect it.
- π‘ Know that FHR bradycardia/variable decels should trigger suspicion.
π References