Cord Presentation

Definition: is a condition when the cord lies in front of the presenting part when the membranes are still intact.

Causes

1. Abnormal presentation or positions :any presentation when the presenting part is not well applied on the cervix as seen in breech, face and brow, transverse lie and occipito -posterior position

2. Contracted pelvis: flat pelvis-platypelloid when the anterior-posterior diameter is reduced.

3. Low implantation of the placenta –placenta praevia

4. Excessively long cord

5. Premature rupture of membrane

6. Grand multiparity- flabby weak muscle tone

7. Multiple pregnancy - small baby

8. Polyhydramnoius – increase mortality

9. High head

10. Prematurity –head too small to fill the birth canal

Diagnosis:

cord will be felt pulsating during vaginal examinationwith the membranes intact.

Management:

1. Prevent rupture of the membranes and compression of the cord

2. Arrange for immediate medical aid

3. Elevate foot of the bed

4. Put patient in any of the positions described in cord prolapse

5. Reassure the patient

6. Prepare for emergency caesarean section if cord is pulsating

Prognosis:

Not good

It carries 50% mortality

Usually better with footling breech then, secondary to compression or spasm of the cord.