In cases in which the interval to delivery is likely to
be prolonged (that is, requiring maternal transport to
a facility where cesarean delivery can be performed),
bladder filling may be a better option. With this technique—
commonly called Vago's method, in reference
to the physician who first described the technique—a
Foley catheter is placed and the bladder is filled with
500 to 750 mL of saline, and then clamped.'" The patient's
enlarging bladder provides upward pressure
on the fetus, thus alleviating the compression on the
cord. Vago described this as an alternative to manual
elevation, which he described as "effective, but
. . . unpleasant for the mother and wearying for the
doctor." He also noted that in his experience, filling
the bladder tends to calm uterine contractions, which
would certainly further relieve pressure on the cord.
Over the years, studies have shown Vago's method
to be effective.'"" To employ this strategy requires
that a cord prolapse tray be immediately available
(Figure 1). Comparison of manual elevation of the presenting
part versus bladder filling shows essentially
equal outcomes between the 2 groups.'^ It should be
noted that the combination of the 2 methods does
not lead to any improvement over using either alone.
Funic reduction. Another method that has been