Cord prolapse

Definition:

Cord prolapse is defined as the presence of cord in front of fetal presenting part and membrane rupture will prolapse through the cervix into the vagina

•         0.6% of deliveries present with cord prolapse (i.e) 1 in 300 deliveries
•         Risk increases with the fetal malpresentation,  especially when the presenting part does not fill the lower uterine segment

Types:

OCCULT PROLAPSE:

•                      The cord is placed by the side of the presenting part and is not felt by the fingers on internal examination. It could be seen on USG or c-section. 

CORD PRESENTATION:

•                      The cord is slipped down the presenting part and is felt lying in the intact bag of membranes.

CORD PROLAPSE:

•                      The cord is lying inside the vagina or outside the vulva following rupture of the membrane.

Incident:

 The incidence of the cord prolapse is about 1 in 300 deliveries. It is the mostly confined to parous women. Incidence is reduced with the increased use of elective c-section in non-cephalic presentation.

Causes:

Malpresentation – the most common 

• being transverse (5-10%)
• Contracted pelvis 
• Prematurity 
• Twins 
• Hydramnios
• Placental factor – placenta previa 
• Iatrogenic – ECV, IPV

Diagnosis:

OCCULT PROLAPSE: 

              It is difficult to diagnose. The possibility should be suspected if there is persistence of variable deceleration of fetal heart rate pattern detected on continuous electronic fetal monitoring

CORD PRESENTATION:

              The diagnosis is made by feeling the pulsation of the cord through the intact membranes.

CORD PROLAPSE:

                   The is palpated directly by the fingers and its pulsation can be felt if the fetus is alive. Cord pulsation may cease during uterine contraction and returns after the contraction passes off.

                   Pulling down the loop for visualization or unnecessary handling is to be avoided to prevent vasospasm.

                   Fetus may be alive even un the absence of cord pulsation.

                   Proper USG for cardiac movement or auscultation for FHS to be done before declaration of fetal death   

Prognosis:

    FETAL:

    1. The fetus is at the risk of anoxia

    2. The blood flow may occluded either due to mechanical compression by presenting part or due to vasospasm of the umbilical cord .

     3. Risk increases to fetus in vertex presentation.

 Prognosis depend interval b/w detection and delivery of the fetus, if the delivered within 10 – 30 min mortality reduced to 5 to 10%

       MATERNAL:

           Risk are incidental due to emergency operative delivery 

especially through vaginal route. 

            Operative delivery involves risk of anesthesia, blood loss and 

infection.

Anticipation and early detection;

INTERNAL EXAMINATION

           1.   Premature rupture of membrane 

            2.  All cases of malpresentation

             3. Twins

              4. Hydramnios or vertex presentation

SURGICAL INDUCTION

               It should be conducted in OT  keeping every thing ready for c-section

                       

Management:

 CORD PRESENTATION:

            Preserve the cord from further injury and infection and carry out delivery of the fetus.

            Once diagnosed donot attempt to pull or replace the cord

            If immediate vaginal delivery is not possible or contraindicated, c-section is best method of delivery. Maintain SIMS position to minimize cord compression.

           A rare occasion in multipara having good uterine contraction with 7-8cm of dilation without any fetal distress.

CORD PROLAPSE:

                 Follow up with the protocol

                                 1.Baby live or dead

                                 2.Maturity of the baby

                                 3.Degree of dilatation

• Tweet
• Share
• Share
• Share
• Share

About Admin

This website for medical students who struggle to study over the books this for yours we are given as a consiced format more...

Related Post