What is cord prolapse?
Cord prolapse is an obstetrical emergency whereby the cord lies in the front of the presenting part with the membranes ruptured. It requires the expertise of an experienced midwife or obstetrician to save the baby’s life.
During this period, the midwife should allay the woman’s anxiety and ensure that he or she provides woman-centered care devoid of disrespect and abuse. Proper information regarding what is happening should be provided to her and her support person or partner.
Risk factors for umbilical cord prolapse
- Abnormal fetal presentation
- Polyhydramnios
- Placenta previa.
- Multiparity
- Abnormal shaped umbilical cord
- Prematurity
- Low birth weight( babies less than 2,500 g)
- Spontaneous or artificial rupture of membranes
- Assisted vaginal delivery such as vacuum or forceps delivery
- Congenital fetal malformations
Diagnosis
A loop of cord may be visible below or beside the presenting part. It can be felt on vaginal examination. It may also be on the Os as in high head.
Cord prolapse is diagnosed when membranes are ruptured.
General management of cord prolapse
Immediate care
- As soon as diagnosis is made, call for for quick attention.
- Explain findings to the pregant mother and birth partner.
- Stop oxytocic drip if it is in-situ.
- Carry out vaginal examination to assess cervical dilation.
- Note and record the time for occurrence of prolapse.
- If the cord is pulsating, handle as little as possible to avoid spasm of blood vessels and prevent exposure to low temperature.
- If the cord is outside the vagina, gently replace to maintain warm temperature(e.g. apply warm saline pack to support).
- Ask assistant to auscultate and record fetal heart rate.
Relieve pressure on the cord by:
- Keep fingers in vagina by using them to hold the presenting part off the cord during contractions.
- Help mother to change position so that her pelvis and buttocks are raised.
- Knee-chest position to help fetus gravitate towards the diaphragm.
- Help mother to lie on her side with wedge or pillow elevating her hips(exaggerated Sim’s position).
- Elevate the foot of the bed.
- Sustain all these pressure by relieving techniques till delivery of baby either per vagina or by Caesarean section.
Specific management of cord prolapse
This depends on the stage of labour at which the diagnosis was made.
First stage: Fetus still alive – delivery not immenient or woman cannot deliver by vagina, Caesarean section is the treatment of choice.
Second stage: Encourage mother to push with contractions. Perform episiotomy. If cephalic presentation, assist labour with vaccum or forceps.
Community: Fetus is still alive – transfer to hospital immediately. Relieve pressure on cord by placing mother in left lateral position and buttocks elevated.
Inform consultant: prepare for emergency Caesarean section on arrival.
Complications of cord prolapse
Poorly managed umbilical cord prolapse is associated with dangers such as fetal hypoxia and death due to cord compression especially in premature and low birth weight babies. However, there are no specific ways of preventing cord prolapse. Pregnant women are usually advised to attend antenatal care regularly and utilize facility-based delivery where there are skilled and qualified birth attendants.
Bottom line
Umbilical cord prolapse is an emergency situation that needs obstetric interventions to save the life of the baby. When this condition occurs in the community, the midwife should carefully transfer to hospital where proper care will be provided.
Again, midwife should avoid performing artificial rupture of membranes (ARM) in pregnant women diagnosed with polyhydramnios in order to minimize the risk of the cord prolapse due to the rushing of the liquor amnii. The midwife should also endeavour to provide respectful and evidence-based care to the woman as well as involve her in decision pertaining her care.