Cord Prolapse
Cord prolapse occurs when the umbilical cord slips ahead of the presenting fetal part, causing compression ➝ fetal hypoxia & bradycardia 🚨.
It is a true obstetric emergency requiring rapid recognition and immediate intervention to prevent perinatal morbidity and mortality.
📂 Types of Cord Prolapse
- 🔴 Overt: Cord visible at the introitus or palpable on vaginal examination (classic presentation).
- 🟠 Occult: Cord lies alongside presenting part, not visible; usually suspected when fetal heart rate (FHR) abnormalities appear.
⚠️ Risk Factors
- 👶 Multiple pregnancy
- 🌊 Polyhydramnios
- 💧 Premature rupture of membranes (PROM), especially if head not engaged
- ↔️ Malpresentation (breech, transverse lie, compound presentation)
- ⏳ Preterm labour
- 🤱 High parity (lax uterus/pelvis)
- 🩺 Artificial rupture of membranes (amniotomy) with high presenting part
🔍 Diagnosis / Assessment (NICE & RCOG)
- 👁️ Clinical examination: Palpable or visible cord at the vaginal introitus in overt cases.
- 📉 Fetal monitoring: Sudden prolonged or variable decelerations → red flag for cord compression.
- 🖥️ Ultrasound: Occasionally shows cord alongside presenting part (mainly for suspected occult prolapse prior to rupture).
- ⚠️ Red flag: Bradycardia or prolonged deceleration in labour must prompt immediate bedside assessment.
🚑 Emergency Management (RCOG Green-top 1999, updated 2023)
- ✂️ Immediate delivery: Emergency caesarean section is definitive treatment unless birth is imminent vaginally.
- ↗️ Maternal positioning: Knee–chest or steep Trendelenburg to relieve cord compression and improve uteroplacental perfusion.
- ✋ Manual elevation: Lift presenting part off the cord during transfer to theatre.
- 💨 Oxygen therapy: High-flow O₂ to improve fetal oxygenation (as adjunct).
- 💊 Tocolysis: Consider short-acting tocolytic (e.g., terbutaline) if contractions need temporary reduction before C-section.
- 💧 Cord protection: Keep exposed cord moist with warm saline–soaked gauze; do not attempt to push cord back inside vagina.
⚡ Complications
- 🧠 Fetal hypoxia / encephalopathy: Acute cord compression reduces oxygen delivery.
- ⚰️ Perinatal death: If hypoxia is prolonged and not rapidly corrected.
🛡️ Prevention / Risk Mitigation
- ⛔ Avoid amniotomy unless the head is well engaged.
- 🔎 Monitor malpresentation closely; consider elective C-section when indicated.
- 📉 Vigilance in polyhydramnios, multiple pregnancies, and preterm labour.
- 🩺 Careful labour management: continuous FHR monitoring in high-risk situations.
📌 OSCE / Teaching Pearls
- 💡 Cord prolapse is an obstetric emergency – emergency C-section unless birth is imminent vaginally.
- 💡 Always describe maternal positioning + manual elevation in OSCE scenarios.
- 💡 Keep exposed cord moist with gauze; do not manipulate inside vagina.
- 💡 Sudden FHR bradycardia or variable decelerations should trigger suspicion immediately.
- 💡 Communicate promptly with theatre and neonatal team for resuscitation preparedness.
📚 References
