Prolapse of Cord

Prolapse of Cord

Prolapse of umbilical cord can be classified as:

·        Occult prolapse in which the cord lies over the face or head of the fetus but can not be felt on vaginal examination

·        Foreying in which the cord precedes the presenting part and usually palpated through the membranes if the cervix is dilated

·        Complete prolapse in which the cord deceds in to the vagina in front of the presenting part

Obstetric factors which favors prolapse of ublical cord are:

-                  Abnormal presentation (Face,Breech, Shoulder, Brow and Transverse)

-                  Multiple pregnancy

-                  Premature rupture of membrane prior to engagement of the presenting part

-                  Contracted pelvis

-                  Hydraminous

-                  Low implantation of placenta

-                  Abnormally long cord

Manegement: - It depends on the fetal condition andpresentation.

If the fetus is alive:

-                  Position the mother in the knee chest position or deep trendelenberg position

-                  Manually pushing the presenting part backward by gloved finger vaginally to relieve off the pressure on the cord till the baby is delivered

-                  The best method of delivery in this case is caesarean section

-                  If the fetus is not alive and the presentation and position is normal vaginal delivery is possible

Complications

Fetal

·        Birth trauma

·        Prematurity

·        Metabolic acidosis

·        Hypoxia

Maternal

·        Lacerations of birth canal if rapid vaginal delivery is carried out

·        Rupture of uterus (malpresentations)

·        Uterine atony (prolonged labour)