Cord Prolapse

Cord Prolapse

Definition: 

it is a condition when the cord lies in front of the presenting part when the membranes are ruptured.

Causes: 

same as for Cord Presentation

Diagnosis:

Is made when the cervix is at least 2cm dilated.

1.           Cord may be felt on vaginal exanimation or seen lying outside the vulva on inspection. It may or may not be pulsating.

2.           It is important for the midwife to make sure that she does not mistake her own pulsation on her thumb for that of the cord. In case of any doubt the cord could be held between two fingers or pressed against the presenting part

3.           Auscultation of the fetal heart sound can also help to confirm the diagnosis especially where there is compression of the umbilical vessels, in such cases the fetal heart may be rapid, slow or irregular.

Management

Management depends on if the fetus is alive or dead and dilatation of the cervix.

·              Position the patient in knee chest position (genu-pectoral) or Sim’s lateral position with he pelvis raised on pillows. This raises t5he pelvis level above the chest. This is the most comfortable position for the woman ; or raise the foot of the

·              bed

·              Arrangefor immediate medical aid and prepare for caesarean section if the cord is still pulsating and fetal heart sound is audible

·              Re-assure the patient – be tactful

·              Make attempts to replace the cord

·              Prevent spasms of the cord (due to prolonged exposure) by wrapping the cord in sterile gauze of warm saline solution.

·              Monitor  fetal heart rate

·              If in the first stage – Caesarean section is done i f cord is still pulsating.

·              If in 2nd stage – give episiotomy and deliver by fundal pressure

·              Forceps delivery – if doctor is around

·              Prevent the woman from walking about when head is not engaged

Management in the districts

·              Give emergency treatment as in the hospital

·              Arrange and transfer the patient to the nearest hospital where there are facilities for instrumental delivery

·              Position the patient to prevent compression on the cord during the journey

·              Sterile gloved hand can be used to apply pressure on the presenting part.

·              Monitor fetal condition on the way once the cord is still pulsating and there is no compression, the baby can still survive even for hours.