Cord prolapse

Abstract

1. Purpose This document outlines the guideline details for the prevention, diagnosis and management of cord prolapse at the Women’s. 2. Definitions Cord Prolapse: the umbilical cord lies in front of or beside the presenting part in the presence of ruptured membranes. Cord presentation: the presence of the umbilical cord between the presenting part of the fetus and the cervix. In both conditions a loop of the cord is below the presenting part. The difference is in the condition of the membranes; if intact it is cord presentation and if ruptured it is cord prolapse. 3. Responsibilities Obstetric and midwifery staff are responsible for identifying and responding to this emergency situation. 4. Guideline 4.1 Incidence The incidence of cord prolapse/ presentation is said to occur in 0.1 0.6% of births1. The predisposition to cord prolapse is higher in a breech presentation and with multiple gestations. 4.2 Risk factors • High / ill fitting presenting part • High parity • Prematurity • Multiple pregnancy • Polyhydramnios • Malpresentations • Obstetric manipulation. 4.3 Prevention • Identification/ awareness of risk factors • Artificial rupture of membranes (ARM) should not be done when the station is high. If ARM is essential to manage a difficult obstetric situation and the head is not engaged and high consider a controlled ARM by senior medical staff in theatre The same procedure should take place in the situation of polyhydramnios. Consider need to identify a cord presentation on ultrasound. 4.4 Clinical recognition Diagnosis of cord prolapse is made by visual inspection or by palpation during vaginal examination where the umbilical cord is felt below or beside the presenting part. Cord prolapse should be suspected with an abnormal fetal heart rate pattern (bradycardia, severe variable decelerations) occurring soon after spontaneous or artificial rupture of membranes. Note: In the presence of predisposing risk factors a vaginal examination should always be performed after the membranes rupture spontaneously or if a fetal bradycardia occurs after rupture of membranes.