CORD PROLAPSE CORD PROLAPSECORD PROLAPSE CORD PROLAPSECORD PROLAPSECORD PROLAPSECORD PROLAPSECORD PROLAPSE – CLINICAL GUIDELINE CLINICAL GUIDELINECLINICAL GUIDELINECLINICAL GUIDELINECLINICAL GUIDELINECLINICAL GUIDELINECLINICAL GUIDELINE CLINICAL GUIDELINE
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1.1. This is to give guidance to all midwives and obstetricians on the recognition and management of an umbilical cord prolapse.
2. The Guidance The Guidance The GuidanceThe Guidance The Guidance The Guidance
2.1. Definition
Cord prolapse is defined as the descent of the umbilical cord through the cervix alongside (occult) or past the presenting part (overt) in the presence of ruptured membranes.
Cord presentation is the presence of the umbilical cord between the fetal presenting part and the cervix, with or without membrane rupture.
2.2. Incidence
The overall incidence of cord prolapse ranges from 0.1% to 0.6%.
With a breech presentation the incidence is 1%.
Cases involving cord prolapse consistently appear in the perinatal mortality enquiries. Congenital malformations account for the majority of adverse outcomes associated with cord prolapse in hospital settings but birth asphyxia is also associated.
The principle causes of asphyxia in this context are:
Cord compression (preventing venous return to the fetus)
Umbilical vasospasm (preventing venous and arterial blood flow to and from the fetus) due to exposure to external environment
2.3. Risk Factors for cord prolapse
Any factor which prevents close application of the presenting part to the lower part of the uterus or the pelvic brim.
2.4. Avoidance of cord prolapse
50% of cases of cord prolapse are a result of obstetric intervention
Artificial Rupture of membranes (ARM) should be avoided if the presenting part is mobile. If ARM is clinically indicated, in the presence of risk factors for cord prolapse, this should be performed with arrangements in place for an immediate caesarean section.
Vaginal examinations and obstetric interventions carry the risk of upward displacement and cord prolapse, particularly with a high presenting part and ruptured membranes. Upward pressure should be kept to a minimum in such cases.
With transverse, oblique or unstable lie, elective admission after 37+0 weeks gestation should be considered. Such women should be advised to present immediately if there are signs of labour or suspected rupture of membranes.
Women with non-cephalic presentations and preterm prelabour rupture of membranes should be offered admission.
2.5. Diagnosis of cord prolapse
Cord presentation or prolapse can occur without physical signs and without fetal heart pattern abnormalities