Obs Emer – Cord prolapse
The document provides information on umbilical cord prolapse, which is the descent of the umbilical cord through the cervix alongside or past the presenting part in the presence of ruptured membranes. It describes different types of cord prolapse, including occult cord prolapse, cord presentation, and overt cord prolapse. The risk factors for umbilical cord prolapse are listed, including fetal malpresentations, abnormal lie, non-engaged presenting part, multiparity, small for dates fetus, preterm labor, PPROM, fetal congenital malformations, polyhydramnios, low-lying placenta, and being the second of twins.
The document outlines the diagnosis of umbilical cord prolapse, which involves vaginal examination, fetal heart rate monitoring, and ultrasound with Doppler for women with risk factors. It also provides good practice points, emphasizing the need to perform speculum examination when membranes rupture in women with risk factors for cord prolapse and to exclude cord prolapse in every case of fetal distress, especially when membranes have been ruptured.
The management of umbilical cord prolapse is detailed, including assessment for fetal viability, expedited delivery, and various measures to relieve compression and vasospasm of the umbilical cord vessels. Principles of management such as manual elevation of the presenting part, bladder filling, knee-chest position, exaggerated Sim’s position, instrumental vaginal delivery, tocolytics, oxygen, and IV fluids are also discussed.
Additionally, the document provides guidance on other measures to ensure fetal viability, perform instrumental vaginal delivery if feasible, and expedite delivery by cesarean section if not suitable for instrumental vaginal delivery. Prevention strategies are also outlined, including advising admission if labor or membranes rupture in case of abnormal lie, speculum examination in case of PPROM, and Doppler ultrasound to detect cord presentation in women with risk factors. The document is authored by Lanka Dasanayake, a Professor of Obstetrics & Gynaecology & Head of the Department of Obstetrics & Gynaecology at the Faculty of Medicine, University of Ruhuna, Sri Lanka.
