Cord presentation or cord prolapse can occur in any situation where the presenting part does not fit well into the maternal pelvis. Occult prolapse cord is placed by side of presenting partnot felt by finger on int. It occurs when a part of the umbilical cord falls adjacent to or below the presenting part of the baby. In developed countries these have advanced to giving intrauterine fetal resuscitation. Funic presentation is more common with malpresentations especially breech and transverse lie. Overt cord prolapse can be diagnosed either by seeing the cord presenting from the vagina, or unexpectedly palpated during a vaginal exam. It may be a transient phenomenon and usually considered insignificant until 32 weeks. In overt umbilical cord prolapse, the cord slips ahead of the presenting part of the fetus and protrudes into the cervical canal or vagina, or beyond. It is good clinical practice to examine for cord presentation or prolapse with each vaginal examination in labour.
In the case of cord presentation and prolapse, blood flow through the umbilical vessels may be compromised from the compression of the cord between the fetus and the uterus, cervix or pelvic inlet. There are certain pregnancy complications which increase the risk of prolapse. Umbilical cord prolapse this is the first edition of this guideline. Cureus umbilical cord prolapse in a labouring patient. The umbilical cord prolapse occurred in association with vertex presentation 66 times 85. A report of 47 cases from the yaounde central hospital, cameroon article pdf available in clinics in mother and child health 7. Oct 20, 2008 presentation and prolapse of the cord. There are a number of risk factors associated with breech birth, including prematurity, multiple pregnancy, hydrocephaly, and. Cerebral palsy from umbilical cord prolapse and compression. Putting the mother in knee chest position and immediate delivery. Prolapse of the cord occurred only once in every 379 eases of vertex presentation, but when the fetal presenting part fitted the lower segment of the uterus less accurately, the incidence rose markedly to 1 in 59 with face presentation. Cord presentation is the presence of one or more loops of umbilical cord between the fetal presenting part and the cervix, without membrane rupture. In both conditions a loop of the cord is below the presenting part. Cord prolapse occurs when the cord lies below or adjacent to the presenting part of the fetus.
Presentation and prolapse of the cord springerlink. Cord prolapse free download as powerpoint presentation. Overt cord prolapse occurs in more than 1% breech deliveries. This makes it susceptible to compression by the presenting part and may result in fetal asphyxia. Prolapsed cord definition of prolapsed cord by medical. The difference is in the condition of the membranes. The frequency of cord prolapse in vertex presentation was 0.
Cord presentation forelying cord is the presence of the umbilical cord. Cephalic than breech presentation or transverse lie. Umbilical cord prolapse and other cord emergencies glowm. Jul 02, 2015 the overall incidence of overt prolapsed cord is between 1 and 61,000 deliveries. Cord prolapse, associated factors and fetal outcome. In the case of breech presentation, the incidence is slightly higher than 1%. Presentation and prolapse of the umbilical cord sciencedirect. Purpose and scope the purpose of this guideline is to describe modalities to prevent, diagnose and manage cord prolapse.
Presentation and prolapse of umbilical cord cope 1951. Apr, 2011 umbilical cord prolapse occurs when a loop of cord is present below the presenting part when the amniotic membranes are ruptured. The fetal head was manually elevated to prevent compression of the umbilical cord and the patient gave birth to a live baby boy with apgar scores of nine and nine. Cord prolapse is descent of the umbilical cord into the vagina ahead of the fetal presenting part with resulting compression of the cord between the presenting part and the maternal pelvis. It is good clinical practice to examine for cord presentation or prolapse with each.
Registered nurse initiated activities decision support tool. This may mean simple manual procedures to help reposition the baby or, in many cases, a planned csection delivery. With overt prolapses, the diagnosis can be confirmed if the cord can be felt on vaginal examination. In cord prolapse, the foetal perinatal mortality is 2550% from asphyxia. Cord prolapse caesarean section human pregnancy free 30. Manual elevation of the presenting part and vagos method bladder filling are the. Oct 15, 20 in addition, umbilical cord prolapse may occur. Purpose this document outlines the guideline details for the prevention, diagnosis and management of cord prolapse at the womens. If the accident occurred outside the hospital, many babies would be dead or severely asphyxiated upon arrival in the. There are a number of risk factors associated with breech birth, including prematurity, multiple pregnancy, hydrocephaly, and uterine abnormalities. However, note that uss is not sufficiently sensitive or specific for identification of cord presentation antenatally and should not be performed routinely to predict cord prolapse.
Umbilical cord prolapse free download as powerpoint presentation. Umbilical cord prolapse gynecology and obstetrics msd. Umbilical cord prolapse should always be considered a possibility when there is a sudden decrease in fetal heart rate or variable decelerations, particularly after the rupture of membranes. An acute fetal bradycardia, or acute declerations of the fetal heart rate in the. The case presented here is unusual because the definition of cord prolapse cannot be applied to it and the lady did not complain of any history of urinary incontinence or hematuria. Some units may also require documentation in the notes the absence of cord presentation at each vaginal examination. Occasionally loops of cord may lie between the lower uterine segment and the presenting part cord or funic presentation. Full text optimal management of umbilical cord prolapse ijwh. Conditions in low resource settings do not allow for some of these advanced techniques. Scribd is the worlds largest social reading and publishing site.
Cord prolapse with a viable fetus should result in delivery of the fetus. Fetal demise and associated factors following umbilical cord. Overt prolapse can also occur with vertex presentation, particularly if membranes rupture spontaneously or iatrogenically before the head is engaged. Incidence of cord prolapse showing the difference in various presentations cord presentation or presentation deliveries no. Examiner who diagnosed umbilical cord prolapse must maintain umbilical decompression until patient is in or. Umbilical cord prolapse is an obstetric complication associated with high perinatal morbidity and mortality. Presentation and prolapse of umbilical cord an analysis of 350 cases. Do not attempt to reduce cord instead, elevate the presenting fetal part to reduce compression and transport to or for emergent csection. Abnormal presentations, such as breech, must be managed carefully to avoid birth injury. Cord presentation the presence of the umbilical cord between the presenting part and the cervix. The principle of prehospital management is to monitor the cord for pulsations and use maternal positioning to prevent compression. Umbilical cord prolapse can be occult or overt and occurs when a segment of umbilical cord advances alongside or ahead of the presenting part of the fetus. Treatment of overt prolapse begins with gently lifting the presenting part and continuously holding it off the prolapsed cord to restore fetal blood flow while immediate cesarean delivery is done. If the cord stops pulsating, the pressure from the presenting part will need to be alleviated, either indirectly using gravity maternal kneechest position or directly, by gently pushing the foetus off the cord.
Cord presenting at the cervix before the presenting part with intact membranes felt on vaginal examination soft pulsating no arm seen during speculum examination but theres no reason to do a spec exam rupture of the membranes cord prolapse. Cord presentation is the presence of the umbilical cord between the fetal presenting part and the cervix, with or without membrane rupture. View the article pdf and any associated supplements and figures for a period of 48 hours. Two pregnant women presenting with umbilical cord prolapse cy hung, p ng, hh yau, cw kam cord prolapse is an obstetric emergency as delay in management is associated with significantly increased neonatal morbidity and mortality. Abnormal fetal positionpresentation and birth injury. In cord prolapse, the foetal perinatal mortality is 2550% from asphyxia due to. It addresses those pregnant women at high risk of or with a diagnosis of cord prolapse in hospital and community settings. Policy code date purpose scope health care setting population. In the case of cord presentation and prolapse, blood flow. Place patient in kneechest position and encourage not to push or cough. Breech presentation in a footling breech, the cord can easily slip between and past the fetal feet and into the pelvis unstable lie this is where the presentation of the fetus changes between transverseobliquebreech and back if 37 weeks gestation, consider inpatient admission until delivery due to risk of cord prolapse. The two types of prolapsed umbilical cords include the following. As long as the membranes are intact there is no risk.
This is important to recognize as it predisposes to cord prolapse and possible fetal death when the membranes rupture. Cord presentation or prolapse should be excluded at every vaginal. It is an obstetrical emergency because the prolapsed cord is vulnerable to compression, umbilical vein occlusion, and umbilical artery vasospasm, which can compromise fetal oxygenation. Aims provide information and practical guidance to enable early diagnosis and efficient initiation ofemergency procedures to ensure the best possible neonatal outcome 3. The overall incidence of cord prolapse ranges from 0. The perinatal mortality rate from cord prolapse is 91 per 1,000. Two pregnant women presenting with umbilical cord prolapse.