Cord Prolapse Management and prevention

Table of Contents

If the cord is outside, gently replace the cord in the vagina (but not in the uterus) to prevent spasm of the cord blood vessels. Minimise handling of the cord for the same reason.
If the patient is in advanced labour with a cephalic presentation, cord compression can be caused by the head. Therefore, the head should be pushed up manually and prevented from descending by filling the
bladder with 500 ml of saline. Intravenous tocolysis may be commenced.
Next, place the patient in the knee chest position.
Delivery should be done as soon as possible if the foetus is alive.

Immediate caesarean section should be done if the patient is in the first stage of labour. The foetal heart should be auscultated
with a hand Doppler just before commencing the operation, as sudden foetal death may have happened. The bladder should be emptied.
Forceps delivery is a quick procedure and is the best option, if the patient is in the second stage of labour and all criteria for
instrumental delivery are satisfied; otherwise caesarean section should be done.
Vacuum extraction is not recommended as it takes at least 20 minutes to build the vacuum.
Caesarean section should be done if cord prolapse occurs during the second stage in a singleton breech presentation.
Breech extraction is recommended only in the case of second of twins.
If the foetus is dead and the lie is longitudinal vaginal delivery can be allowed, if there are no contraindications for vaginal delivery. Labour can be augmented with oxytocin.

Cord presentation cannot be identified during the antenatal period by ultrasound scanning.
Patients who are at high risk of cord prolapse if pre-labour rupture of membranes occur, should be admitted at 37 weeks. This includes those with transverse lie, oblique lie, unstable lie and breech
presentation.
In those with a high head or breech presentation amniotomy should delayed, till the presenting part is well descended.
Cord presentation should always be excluded by vaginal examination before amniotomy is done. The liquor should always be drained carefully and slowly
A vaginal examination should be done soon after spontaneous rupture of membranes to Cord Prolopse exclude cord prolapse.
Foetal heart sounds should be auscultated soon after spontaneous or artificial rupture of membranes to exclude cord prolapse.