Umbilical cord prolapse
BY Shula. S(BSc.,MSc. in clinical Midwifery
Specialty)
AMU
Dec,2024
12/20/2024 1
Presentation
outlines
Definition
classifications
Risk factors
Management
12/20/2024 2
Introduction
12/20/2024 3
Continue…
Also it is where the umbilical cord descends through the
cervix, with (or before) the presenting part of the fetus in
the presence of ruptured membrane.
It affects 0.1 – 0.6% of births.
But varies with fetal presentation:
cephalic = 0.5%,
frank breech = 0.5%,
complete breech = 5%,
footling breech = 15%,
transverse lie = 20%) & It is an obstetric emergency,
with a fetal mortality rate of 91 per 1000.
12/20/2024 4
CLASSIFICATION
Overt UCP: Protrusion of the UC in advance of the
fetal presenting part with ruptured fetal membranes.
Occult UCP: Cord descends alongside, but not past,
the presenting part with intact / ruptured fetal
membranes.
Cord presentation: Prolapse of UC below the level
of the presenting part with intact fetal membranes.
12/20/2024 5
Pathophysiology
Umbilical cord prolapse is where the umbilical cord
descends through the cervix, with (or before) the
presenting part of the fetus. Subsequently, fetal
hypoxia occurs via two main mechanisms:
Occlusion – the presenting part of the fetus presses
onto the umbilical cord, occluding blood flow to the
fetus.
Arterial vasospasm – the exposure of the umbilical
cord to the cold atmosphere results in umbilical
arterial vasospasm, reducing blood flow to the fetus.
12/20/2024 6
Risk factors
Any feto-maternal factors that end up improper fitting
of the presenting part into maternal pelvis.
General:
Malpresentations,
unengaged presenting part,
prematurity,
multifetal gestation,
PROM,
abnormal placentation,
12/20/2024 7
General
multiparity,
polyhydramnios,
long UC,
pelvic deformities,
uterine tumors/malformations,
congenital anomalies,
low birth weight less than 2.5kg.
12/20/2024 8
Procedure related
ARM with unengaged fetal presenting part,
Intrauterine pressure monitor catheter insertion,
vaginal manipulation of the fetus with ruptured
membranes,
Amnioinfusion / Amnioreduction,
ECV,
stabilization induction.
12/20/2024 9
DIAGNOSIS
Occult UCP:
Presence of severe prolonged fetal bradycardia or
moderate to severe variable decelerations after a
previous normal tracing on CTG/Pinnard
stethoscope or fetal death.
Overt UCP:
Presence of palpable cord (pulsatile or non-
pulsatile) on pelvic examination
or visible cord outside the introitus.
12/20/2024 10
Diagnosis
Cord presentation:
Loops of cord are palpated through the fetal
membranes on digital vaginal examination or
seen in front of the presenting part on ultrasound
examination.
12/20/2024 11
Management
General measures
Call for assistance
Secure IV fluid
Check for cord pulsation. If absent, confirm fetal heart
beat with fetoscope or U/S
Discontinue oxytocin if being given.
Careful pelvic examination immediately after
spontaneous rupture of fetal membranes.
12/20/2024 12
Management
Prepare for resuscitation of the newborn.
In cord presentation, do not rupture fetal membranes
at any stage of labor; deliver the fetus by C/S.
Monitor FHB while preparing for delivery
12/20/2024 13
Management
Maneuvers to reduce fetal presenting part pressure on
the cord:
1. Funic decompression:
Examiner‘s hand is maintained in the vagina to elevate
the presenting part off of the UC while preparations for
an emergency c/d are being made.
Do not manipulate the cord.
Avoid exposure of the cord to cold environment so as to
avoid cord spasm (keep in vagina).
Client be placed in steep Trendelenberg or knee-chest
position.
12/20/2024 14
Fig .1. Trendelenburg position
12/20/2024 15
Fig .2.Knee-Chest Position
12/20/2024 16
Fig 3.Modified sims position
12/20/2024 17
2. Bladder filling
Insert Foley catheter into maternal bladder
then fill bladder with 500-700 ml of normal saline with
the patient in Trendelenberg position
It was used during referral.
12/20/2024 18
Fig. 4.Bladder filling with Foley catheter
12/20/2024 19
Fig. 5.Pushing the head up and bladder filling with Foley catheter
12/20/2024 20
Management
3. Tocolysis
If the woman is in the second stage of labor:
Expedite vaginal birth if deemed quicker than
cesarean section
Obstetric vacuum is preferable over forceps, if
prerequisites are met.
If there is malpresentation or prerequisites for
instrumental delivery are not fulfilled, immediate C/S.
12/20/2024 21
Management
REMARK:
Delivery of the fetus should be accomplished within
30 minutes from the time of diagnosis.
12/20/2024 22
PREVENTION
Avoid ARM if the presenting part isn’t well
applied/engaged or do it with simultaneous fundal
pressure.
Avoid disengaging fetal presenting part when
performing procedures.
Incidental finding of cord presentation on U/S should
be followed to decide mode of delivery.
12/20/2024 23
