CORD PROLAPSE

Josephus L. Mopon Med III A SWU MHAM

Definition: Umbilical cord prolapse (UCP) is a rare, obstetrical emergency that occurs when the umbilical cord descends alongside or beyond the fetal presenting part.

 .When the cord is compressed or squeezed (for example, between the baby and the wall of the uterus or vagina), the baby's supply of blood and oxygen is cut off. The lack of oxygen ( birth asphyxia ) can lead to severe damage or death if the problem is not taken care of within minutes.

Types:

 estimated to occur in 0.14% to 0.62% of pregnancies, with perinatal mortality ranging between 36 and 345 per 1,000 births. the overall perinatal mortality has decreased from 375 per 1,000 births in 1948 to as low as 36 per 1,000, probably because of improvements in neonatal intensive care and immediate delivery by cesarean section once cord prolapse is

Vertex presentation: 0.4% Frank Breech: 0.5% Complete Breech: 4-6% Footling Breech: 15-18%

Risk Factors:

 These factors that predispose to umbilical cord prolapse are largely related to conditions that result in a poor fit between the fetal presenting part and the maternal bony pelvis, which allow the cord to prolapse past the fetal presenting part.

Signs:
Umbilical Cord visualized in vagina or at vulva Umbilical Cord palpated on pelvic exam Fetal Distress on EFM Visualize using UTZ

Prognosis:
Depends upon fetal condition at the time of diagnosis, status of the cervix, and appropriate intervention.

General Management:
1. Emergent Cesarean Section; Vaginal delivery only if imminent. 2. Deliver as Intrauterine Fetal Demise (stillbirth) if fetus has died (Check for cord pulsations, check for fetal heart sounds, and obstetric ultrasound to assess heart activity). 3. Pre-hospital cord prolapse noted at home by patient (Let patient assume a deep knee-chest position because it may relieve enough pressure on the umbilical cord and so oxygen can still get through to the baby, emergent

1. Tocolysis with Terbutaline 0.25 mg SC - 2-adrenergic receptor agonist that stops the uterine contractions, relieving pressure on the cord; suppresses premature labor - contraindication: cardiac arrhythmias - S/E: Maternal - Cardiac or cardiopulmonary arrhythmias, pulmonary edema, myocardial ischemia, hypotension, tachycardia Fetal - Fetal tachycardia, hyperinsulinemia, hypoglycemia,

Management: Temporizing measures to relieve cord pressure

2. Adjust maternal position to reduce cord pressure by a. raising foot of the bed (Trendelenburg's Position), b. Sims' position
Mother in left lateral decubitus position

c. Genu-pectoral position
Mother in knee-chest position

THANK YOU! =D

Resouces:
www.sonoworld.com my.clevelandclinic.org www.merck.com www.uptodate.com www.hon.ch www.fpnotebook.com Stedmans Medical Dictionary, 28th Ed. Williams OBSTETRICS, 23rd Ed. Articles: a. Umbilical Cord Complications (Author: Marie Helen Beall, MD, Clinical Professor, Geffen School of Medicine, University of California at Los Angeles; Vice Chair, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center), Aug 3, 2009. b. Is it umbilical cord prolapse? (Source: Contemporary OB/GYN By: Keith Eddleman, MD, Victoria Belogolovkin, MD Originally published: October 1, 2005)