Cord prolapse

• Cord prolapse is an obstetric emergency where the umbilical cord descends through the cervical canal ahead of the presenting part of the foetus or alongside it when the membranes have ruptured.
• This condition can lead to cord compression and subsequent foetal hypoxia, making it a critical situation that requires immediate intervention.

• Cord prolapse is relatively rare, occurring in approximately 0.1% to 0.6% of all deliveries.
• The risk is higher in pregnancies with abnormal foetal presentations (such as breech or transverse lies), multiple gestations, and those with excessive amniotic fluid (polyhydramnios).

• The prolapse of the umbilical cord occurs when the presenting part of the foetus does not fit snugly against the cervix, creating a space for the cord to slip through.
• Once prolapsed, the cord can become compressed between the foetus and the maternal pelvis or the walls of the vagina, reducing or completely obstructing blood flow through the cord.
• This leads to decreased oxygen and nutrient delivery to the foetus, potentially causing foetal distress or death if not promptly managed.

• Premature rupture of membranes.
• Abnormal presentations (e.g., breech, transverse).
• Multiple pregnancy (twins, triplets, etc.).
• Polyhydramnios.
• Long umbilical cord.
• Low birth weight or preterm foetus.
• Multiparity (having given birth two or more times).
• Use of artificial rupture of membranes (ARM) for induction or augmentation of labour.

• Sudden foetal bradycardia (slow heart rate) or variable decelerations observed on the foetal heart rate monitor following rupture of membranes.
• Visual or palpable identification of the umbilical cord in the vagina or protruding from the cervical os.

Diagnosis is primarily clinical, based on the observation of the cord in the vagina or felt on digital examination following the rupture of membranes, especially if associated with abnormal foetal heart rate patterns.

Immediate Actions:

• Call for help immediately; this is an obstetric emergency.
• The mother should be instructed to assume the knee-chest position or a Trendelenburg position (lying on her back with her legs raised higher than her head) to relieve pressure on the cord.
• Manual elevation of the presenting foetal part off the cord by a healthcare provider via a vaginal examination can reduce compression until delivery.
• Oxygen administration to the mother can help increase foetal oxygenation.
• Prepare for immediate delivery, most safely achieved by caesarean section. If the cervix is fully dilated and the foetal head is low in the pelvis, a vaginal delivery may be attempted under close monitoring.

Surgical Treatment:

• Caesarean section is often the safest and quickest way to deliver the baby in the case of cord prolapse, especially if foetal distress is evident.

• The outcome depends on the promptness of diagnosis and delivery.
• With rapid intervention, the prognosis for the foetus is generally good.
• Delayed intervention may lead to foetal hypoxia, acidosis, and potentially death.

• Cord prolapse is a relatively rare obstetric emergency, which requires prompt diagnosis and delivery to prevent foetal complications from cord compression.
• Diagnosis is based on the observation or palpation of the cord in the vagina following the rupture of membranes, associated with abnormal foetal heart rate patterns.
• Immediate intervention is required through Trendelenburg positioning, manual elevation of the presenting foetal part, oxygen administration and preparation for immediate delivery (caesarean section).
• Medical students should understand the risk factors, clinical presentation, diagnostic approach, and management principles.