Prolapse of Cord

Prolapse of umbilical cord can be classified as:

· Occult prolapse in which the cord lies over the face or head of the fetus but can not be felt on vaginal examination

· Foreying in which the cord precedes the presenting part and usually palpated through the membranes if the cervix is dilated

· Complete prolapse in which the cord deceds in to the vagina in front of the presenting part

Obstetric factors which favors prolapse of ublical cord are:

- Abnormal presentation (Face,Breech, Shoulder, Brow and Transverse)

- Multiple pregnancy

- Premature rupture of membrane prior to engagement of the presenting part

- Contracted pelvis

- Hydraminous

- Low implantation of placenta

- Abnormally long cord

Manegement: - It depends on the fetal condition andpresentation.

If the fetus is alive:

- Position the mother in the knee chest position or deep trendelenberg position

- Manually pushing the presenting part backward by gloved finger vaginally to relieve off the pressure on the cord till the baby is delivered

- The best method of delivery in this case is caesarean section

- If the fetus is not alive and the presentation and position is normal vaginal delivery is possible

Complications

· Birth trauma

· Prematurity

· Metabolic acidosis

· Hypoxia

· Lacerations of birth canal if rapid vaginal delivery is carried out

· Rupture of uterus (malpresentations)

· Uterine atony (prolonged labour)