Prolapse of the Umbilical Cord
Prolapse of the Umbilical Cord
Prolapse of the umbilical cord is when the cord lies below the presenting part of the fetus. The cord may prolapse in front of the presenting part, into the vagina, or through the introitus. Occult prolapse is when the cord is palpated through the membranes but does not drop into the vagina.
Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. In a prolapse, the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby.
Risk Factors for Prolapse of the Umbilical Cord
- Malpresentation of the fetus (such as breech)
- Unengaged presenting part
- Small or preterm fetus
- Multiple gestation
- High parity
Risks Associated with Prolapse of the Umbilical Cord -
Total or partial occlusion of the cord, resulting in rapid deterioration in fetal perfusion and oxygenation.
Assessment Findings -
- Sudden fetal bradycardia (i.e., prolonged decelerations).
- Prolapsed umbilical cord that may be felt with a SVE or visualized in or protruding from the vagina.
Medical Management -
- Delivery must be expedited with the greatest possible speed to reduce mortality and morbidity rate associated with cord prolapse.
- If foetus is alive, and the woman is in 1st stage of labour immediate caesarean section is performed.
- Administer oxygen by mask to reduce foetal hypoxia.
- In second stage of labour, a liberal episiotomy and bearing down by the mother to deliver the baby. This is more possible in case of a multi-gravida. Squatting position is also helpful in multi-gravida.
- Where the presentation is cephalic, delivery is expedited by application of forceps or vacuum extraction.
- To release pressure on the cord, foot end of the bed is raised before preparation for immediate delivery can be arranged.
- Occlusion of the cord may be partially relieved by lifting the presenting part off the cord with a vaginal exam. The examiner’s hand remains in the vagina, lifting the presenting part off the cord until delivery by cesarean.
- Request assistance and notify the medical provider.
- Explain the situation to the woman and family and that interventions are necessary to expedite delivery.
- Explain to the woman the importance of her assistance.
- Recommend position changes such a knee–chest position or Trendelenburg to try to relieve pressure on the occluded cord.
- Administer O2 at 10 L/min by mask.
- Give IV fluid hydration bolus.
- Discontinue oxytocin.
- Administer a tocolytic agent to decrease uterine activity,
- Move toward emergency delivery. If birth is imminent, the provider may proceed with vaginal delivery. If birth is not imminent, anticipate and prepare for emergency cesarean section.
- If the cord is lying outside the vagina gently replace it back. Record F.H.S. Cover the cord loosely with a sterile gauge piece soaked in warm normal saline with gloved hands.
- Attempt to relieve the pressure on the cord, specially during a contraction. Keep finger in the vagina and hold the presenting part off the cord.
- Position the mother with her buttocks higher than her shoulders by elevating the foot end of the bed, or placing her in a knee chest position or by placing two large pillows or rubber wedges under the buttocks [Exaggerated Sim’s lateral. All these positions attempt to gravitate the foetus towards the mother’s diaphragm relieving the compression on the cord. These measures need to be maintained until the baby is delivered either vaginally or by caesarean section. Other positions that can be used are knee-chest and Trendelenburg position.
- While working in the community, if foetus is alive, transfer the woman immediately by ambulance to a hospital.
- Carry out the same procedures to relieve the pressure on the cord with mother in an exaggerated Sim’s position.
- Accompany the mother to the hospital.
- Maintain proper record of the action taken.