Cord prolapse is a rare but potentially life-threatening obstetric emergency that occurs when the umbilical cord descends through the cervix or birth canal ahead of the presenting part of the fetus.

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This can lead to compression of the cord, compromising fetal blood flow and oxygenation, and necessitates prompt diagnosis and management to minimize the risk of adverse outcomes. Here’s a guide to the diagnosis and management of cord prolapse:

Contents

Diagnosis:

Clinical Presentation:

Cord prolapse may present with sudden onset of fetal bradycardia or variable decelerations on fetal heart rate monitoring.
Visual inspection or digital examination during vaginal examination may reveal the prolapsed umbilical cord protruding through the cervix or birth canal.

Fetal Monitoring:

Continuous electronic fetal monitoring (EFM) should be initiated immediately to assess fetal heart rate patterns and detect signs of fetal distress.
Fetal heart rate changes, such as severe or persistent bradycardia, variable decelerations, or loss of variability, may indicate cord compression and should prompt further evaluation and intervention.

Vaginal Examination:

A sterile vaginal examination should be performed promptly to confirm the diagnosis of cord prolapse and assess the position of the presenting part relative to the umbilical cord.
Careful manipulation should be exercised during examination to avoid further cord compression or injury.

Management:

Call for Assistance:

Notify the obstetrician, midwife, or healthcare team immediately to mobilize resources and initiate appropriate interventions.
Activate the obstetric emergency response team and prepare for expedited delivery if necessary.

Positional Maneuvers:

Position the mother in a modified Trendelenburg or knee-chest position to alleviate cord compression and reduce pressure on the cord.
Elevating the mother’s hips or placing her in a lateral tilt position may also help alleviate cord compression and improve fetal perfusion.

Manual Elevation of Presenting Part:

Gentle manual elevation of the presenting part (e.g., pushing the fetal head or buttocks upward) may be attempted to relieve pressure on the umbilical cord and improve fetal blood flow.
Avoid excessive manipulation or forceful traction, which may cause further cord compression or trauma.

Amnioinfusion:

If there is sufficient amniotic fluid present, consider performing amnioinfusion to cushion the umbilical cord and reduce cord compression during contractions.
Administer warmed, sterile normal saline or Ringer’s lactate solution into the uterine cavity under ultrasound guidance to maintain adequate amniotic fluid volume.

Emergency Cesarean Section:

If fetal distress persists or if immediate delivery is indicated due to severe cord compression, obstetric emergencies, or non-reassuring fetal status, expedite delivery via emergency cesarean section.
Prepare for rapid anesthesia induction, surgical intervention, and neonatal resuscitation as needed to minimize the risk of adverse fetal outcomes.

Continuous Fetal Monitoring:

Maintain continuous fetal monitoring throughout labor and delivery to assess fetal well-being, monitor for signs of fetal distress, and guide clinical decision-making.

Maternal Monitoring and Support:

Monitor maternal vital signs, oxygenation, and hemodynamic stability during the management of cord prolapse.
Provide emotional support, reassurance, and clear communication to the mother and her family during this stressful and challenging situation.

Documentation and Debriefing:

Document the details of the cord prolapse event, including timing, interventions performed, maternal and fetal responses, and outcomes.
Conduct a multidisciplinary debriefing session with the healthcare team to review the management of the cord prolapse, identify areas for improvement, and implement strategies to prevent recurrence in the future.

Cord prolapse requires prompt recognition, decisive action, and coordinated teamwork to optimize maternal and fetal outcomes. By following established protocols, implementing appropriate interventions, and prioritizing fetal well-being, healthcare providers can effectively manage this obstetric emergency and mitigate the risk of adverse consequences for both mother and baby.