Module 3
Cord presentation
OBJECTIVES
Definition
Risk factors
Prevention
Diagnosis
Principles
Management
Definition
Is an obstetric emergency where the umbilical cord passes
through cervix into the vagina in advance of the fetal
presenting part
Prolapsed cord may be visible at the lower edge of
vagina(rare)
Umbilical cord lies beside or just ahead of the fetal skull
May be neither visible nor palpable
Cord becomes trapped between fetal presenting part &
maternal bony pelvis
Cord prolapse image
Signs
Abnormal findings on FHR
Fetal hypoxia
May present as severe, sudden deceleration
Prolonged bradycardia
Recurrent moderate-to-severe variable
deceleration
NB: Malpresentation increase the risk of
cord prolapse during rupturing of
membranes
Risk factors
AROM- presenting part not engaged
Placement of a fetal scalp electrode or
intrauterine pressure catheter
Amnioinfusion
Attempted rotation of the fetal head
from OP to OA
External cephalic version(ECV),
internal version or breech extraction
Fetal malpresentation
Prevention measures
Avoidance of an aminiotomy before
engagement
Applying mild fundal pressure during
placement of fetal scalp electrode
Advising mother to remain in bed after
AROM until prolapse & FHR
abnormalities can be excluded
Diagnosis
Vaginal examination
Pulsating mass can be felt within or
extruding from vagina
Fetal bradycardia (<120 bpm)
Variable decelerations of FHR
PRINCIPLES
Cord prolapse may result in fetal hypoxia
Prompt delivery by caesarean section within
30 minutes, improve neonatal outcomes
Vaginal delivery can be performed more
rapidly
Reduce pressure on fetal presenting part
Midwife’s gloved fingers are left in vagina
Pushing presenting part upward to relieve
cord compression
Management of a prolapsed umbilical
cord
Confirm gestational age & FHR with
fetoscope or doppler
If fetus ia alive, perform a vaginal
examination to diagnose stage of labour
If fully dillated , immediately deliver
the baby by vacuum or forceps
If not fully dilated, call for C/S
emergency transfer to hospital
Management of a prolapsed umbilical
cord
Call for help & inform mother of emergency
Ask assistant to administer 4-6l per minute
via facemask & insert an IV line
In first stage
Put on sterile gloves
Insert dominant hand into vagina
Place other hand on abdomen in supra pubic
region to keep presenting part out of pelvis
Management of a prolapsed umbilical
cord
Administer salbutamol 0.5 mg IV slowly
over 2 minutes to reduce contractions
Perform an immediate C/S
IN SECOND STAGE OF LABOUR
Expedite delivery with episiotomy &
vacuum extraction or forceps
Prepare for resuscitation of newborn
Management of a prolapsed umbilical
cord
If there is time delay in performing the
surgery;
Place two fingers or an entire hand into
vagina to elevate presenting part off cord
Place mother in knee-chest or steep
trendelenburg position
Consider bladder filling
Assistant monitors FHR to see if cord
compression is adequately relieved
Midwife maintains the position until fetus is
born via C/S
Management of a prolapsed
umbilical cord
If cord prolapse is present
Replace the cord gently into vagina vault
using wet gauze to prevent vasospasm
Moist tampon or 4x4 gauze can be inserted
gently into vagina below cord to help hold it
in place
If cord compression is relieved, place
woman in left lateral(Sims) position, with a
pillow under hips
Management of a prolapsed umbilical
cord
During transfer, in delivery unit or
operating room
Verify FHR and obtain a tracing
C/S is not indicated if fetus is deceased
Recording and interpretation
Document and date all activities
Document all resuscitation efforts
Management of a prolapsed
umbilical cord
Store cardiotocograph (CTG) tracings
in a safe place
Write an incident report
