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CORD PRESENTATION/
CORD PROLAPSE Definitions
• Cord presentation: a condition in which the
umbilical cord is in front of the presenting part of the fetus with the membranes intact(not ruptured).
• Cord prolapse: this is a condition in which
the umbilical cord is in front of the presenting part of the fetus with the membranes ruptured. 07/25/2024 07/25/2024 types • Occult prolapse: the prolapsed cord is contained within the uterus usually by the side of the presenting part unnoticed
• Overt prolapse: the cord protrude into the
vagina
07/25/2024 07/25/2024 Overt Prolapse
07/25/2024 07/25/2024 Incidence • Incidence of cord prolapse is 1 in 300 deliveries • More in multigravida
• Etiology: Anything that interferes with the
perfect adaptation of the presenting part to the lower uterine segment and disturbing ball valve action may favor cord prolapse. 07/25/2024 Predisposing factors
07/25/2024 Contd..
07/25/2024 Diagnosis • Difficult to diagnose • Suspect if persistence of variable deceleration of fetal heart rate pattern • Cord presentation: feeling of pulsation of the cord through the intact membranes • Cord prolapse: cord palpated by fingers and pulsation if fetus is alive
07/25/2024 Consequence of UCP • The cord is often compressed by either the shoulder, breech or head . • A fetal heart rate pattern that suggest hypoxaemia (eg severe bradycardia, severe variable accelerations) may be the clue especially in occult prolapse.
07/25/2024 Management • Diagnosed early , or perhaps even prevented
• Risk factors such as malpresentation,
Polyhydramnios, a high presenting part or a structural anomaly should alert possibility of cord prolapse.
07/25/2024 Contd.. • Avoidance of ARM in cases of cord presentation would prevent cord prolapse • Making sure that there is no cord presentation before membranes rupture • Rupturing membranes gradually and guiding the draining of flow - it avoid sudden decompression 07/25/2024 METHODS OF ALLEVIATION OF PRESSURE ON THE PROLAPSED CORD Alleviation of pressure on the prolapsed cord until delivery can be achieved through by : 1. Digital disengagement of the presenting part 2. Raising the maternal pelvis (Tredelenburgs position or sim’s position) 3.07/25/2024 Filling of the maternal bladder 07/25/2024 DELIVERY • If the cervix is not fully dilated, prompt delivery through emergency caesarean section offers the best chance of favourable fetal outcome. • If the fetus is dead, then manage labour as indicated
