05/03/2025
Cord Prolapse
Cord prolapse is an obstetric emergency that occurs when the umbilical cord descends through the cervix ahead of or alongside the presenting fetal part, leading to cord compression and compromised fetal oxygenation. If not managed promptly, it can result in fetal hypoxia, asphyxia, or stillbirth.
1. Types of Cord Prolapse
1. Occult Cord Prolapse – The cord slips alongside the presenting part but remains undetectable on va**nal examination.
2. Overt Cord Prolapse – The cord descends through the cervix and is visible at the va**nal opening.
3. Funic Presentation – The cord is felt through intact membranes before rupture, indicating a high risk of prolapse.
2. Causes and Risk Factors
Abnormal Fetal Presentations (e.g., breech, transverse lie)
Polyhydramnios (excess amniotic fluid)
Preterm Labor or Low Birth Weight
Artificial Rupture of Membranes (ARM) before head engagement
Multiple Pregnancy
Placenta Previa or High-lying Placenta
Long Umbilical Cord
3. Signs and Diagnosis
Sudden fetal distress (variable or prolonged decelerations on CTG)
Cord palpation on va**nal examination (soft, pulsating structure)
Visible cord at the va**nal opening in overt prolapse
History of sudden rupture of membranes with fetal heart rate abnormalities
4. Emergency Management
A. Immediate Actions (First Responder Measures)
Call for help immediately (alert obstetric and neonatal teams).
Position the mother to relieve pressure on the cord:
Knee-Chest Position – Mother kneels with chest down and hips elevated.
Trendelenburg Position – Mother lies supine with head lower than feet.
Manually elevate the presenting part to reduce cord compression.
Keep the cord moist with warm saline-soaked gauze if outside the va**na.
Avoid handling the cord excessively to prevent vasospasm.
B. Definitive Management
Emergency Cesarean Section (CS) – The preferred mode of delivery.
Vaginal Delivery (if fully dilated and head engaged) – Only in selected cases with expert
