Definition
Cord prolapse occurs when the umbilical cord slips ahead of the presenting part of the fetus, resulting in the cord being compressed during delivery, leading to fetal hypoxia.
Types of Cord Prolapse
- Overt Cord Prolapse: The cord descends through the cervix into the vagina and may be visible externally.
- Occult Cord Prolapse: The cord lies alongside the presenting part but is not visible externally.
Risk Factors
- Multiple pregnancy
- Polyhydramnios (excess amniotic fluid)
- Premature rupture of membranes (PROM), especially when the fetus is not engaged
- Malpresentation (e.g., breech, transverse lie)
- Preterm labor
- High parity
- Artificial rupture of membranes (amniotomy)
Diagnosis
- Clinical Examination: Cord may be visible at the introitus or palpable on vaginal examination.
- Fetal Monitoring: Sudden fetal heart rate decelerations (variable or prolonged decelerations) may suggest cord compression.
- Ultrasound: Can occasionally help to visualize cord prolapse.
Management
- Emergency Delivery: Immediate delivery is required, usually via caesarean section, to prevent fetal hypoxia.
- Positioning: Place the mother in Trendelenburg or knee-chest position to relieve pressure on the cord.
- Manual Elevation of the Presenting Part: During transport to the operating room, manual elevation of the presenting part can help to relieve cord compression.
- Oxygen Therapy: Administer oxygen to the mother to improve fetal oxygenation.
- Tocolytics: In some cases, tocolytics (medications to relax the uterus) may be given to reduce contractions and minimize cord compression.
Complications
- Fetal Hypoxia: Due to cord compression, the fetus may suffer from oxygen deprivation, leading to brain injury or death.
- Stillbirth: Prolonged or severe cord prolapse can lead to fetal death.
Prevention
- Avoid amniotomy when the fetal head is not engaged.
- Monitor for fetal malpresentation and perform ultrasound assessments if necessary.
- In high-risk cases (e.g., malpresentation), consider caesarean delivery before labor onset.