Anesthesia for Umbilical Cord Prolapse

Anesthesia for the Complicated Pregnancy

UMBILICAL CORD PROLAPSE

Prolapse of the umbilical cord complicates 0.2–0.6% of deliveries. Umbilical cord compression follow-ing prolapse can rapidly lead to fetal asphyxia. Predisposing factors include excessive cord length, malpresentation, low birth weight, grand parity (more than five pregnancies), multiple gestations, and artificial rupture of membranes. The diagnosis is suspected after sudden fetal bradycardia or pro-found decelerations and is confirmed by physical examination. Treatment includes immediate steep Trendelenburg or knee–chest position and manual pushing of the presenting fetal part back up into the pelvis until immediate cesarean section under gen-eral anesthesia can be performed. If the fetus is not viable, vaginal delivery is allowed to continue.