CORD PRESENTATION
AND PROLAPSE
Mrs.Hemalatha,CON,SNMC,AGRA
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DEFINITION
Umbilical cord
prolapse is a
condition in which
the umbilical cord
descends alongside
or below the
presenting part.
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02/13/25 Mrs.Hemalatha,CON,SNMC,AGRA
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ETIOLOGY
Improper fitting of the presenting part into the
maternal pelvis
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Malpresentation
Mrs.Hemalatha,CON,SNMC,AGRA
Contracted pelvis
Prematurity
Twins
Hydramnios
Placental factor
Iatrogenic
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TYPES
Occult cord prolapse The cord is placed by the side of
the presenting part and is not felt by the fingers on
internal examination. It can occur with intact or
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ruptured membranes.
Mrs.Hemalatha,CON,SNMC,AGRA
Cord (funic) presentation The cord is slipped down
below the presenting part and is felt lying in the intact
bag of membranes. The umbilical cord can be palpated
on vaginal examination.
Overt cord prolapse The cord lies inside the vagina or
outside the vulva following rupture of the membranes.
It is the most common type.
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02/13/25 Mrs.Hemalatha,CON,SNMC,AGRA
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02/13/25 Mrs.Hemalatha,CON,SNMC,AGRA
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DIAGNOSIS
Occult cord prolapse
It is difficult to diagnose
clinical features of fetal bradycardia or
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prolonged foetal heart rate deceleration
confirmation is by transvaginal sonography
Mrs.Hemalatha,CON,SNMC,AGRA
Cord presentation
feeling the pulsation of the cord through the
intact membranes
Overt cord prolapse
palpated by the fingers as the membranes are
absent 8
pulsation can be felt if the fetus is alive.
MANAGEMENT
CORD PRESENTATION
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No attempt should be made to repalce the cord.
If immediate vaginal delivery is not possible or
Mrs.Hemalatha,CON,SNMC,AGRA
contraindicated, LSCS is the best
A rare occasion in a multipara with longitudinal lie
having good uterine contractions with the cervix ¾
dilated, without any evidence of fetal distress.
Watchful expectancy can be adopted till full dilatation
of the cervix, when the delivery can be completed by
forceps or breech extraction.
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Management of Cord Prolapse
CORD PROLAPSE
Baby live/dead Maturity of baby
Cervical dilatation
Baby alive Baby dead
-Confirm with USG
Immediate vaginal delivery Immediate safe vaginal delivery -W/F spontaneous
labour
not possible/contraindicated - Destructiveoperation
Vertex Breech
Forceps or Ventouse Breech extraction
First Aid Definitive
Management
- Bladder Filling -(16 Foley catheter, 500-800ml of saline)
C.S
- Lift the presenting part off the cord 10
- Postural treatment ( Mother in trendelenburg or knee-chest
position)
02/13/25 Mrs.Hemalatha,CON,SNMC,AGRA
VASAPRAEVIA
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DEFINITION
When a fetal blood vessel lies over the os in
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front of the presenting part is called vasapraevia.
Mrs.Hemalatha,CON,SNMC,AGRA
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DIAGNOSIS
It may be diagnosed anenatally using
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Ultrasound
Mrs.Hemalatha,CON,SNMC,AGRA
Palpated on vaginal examination when membranes are
intact.
Speculum examination
SIGNS
When the membranes rupture, fetal vessels also rupture.
- Fresh vaginal bleeding
- Fetal distress
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MANAGEMENT
Fetal heart rate should be monitored
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If the mother is in the first stage of labour fetus
Mrs.Hemalatha,CON,SNMC,AGRA
is still alive, emergency caesarean section is
carried out.
In second stage delivery may be by vaginal
delivery.
There is high fetal mortality with this ,so
pediatrician should be present for the birth.
If baby born alive resuscitation, haemoglobin
estimation and blood transfusion will be done . 14
REFERENCES:-
Dutta D.C; Text book of obstetrics; sixth edition
2004;Kolkata, new central book agency(P) Ltd.
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Jacob Annamm ;A comprehensive text book of
Mrs.Hemalatha,CON,SNMC,AGRA
midwifery ;First edition :2005;new delhi. Jaypee
brothers medical publishers (P) Ltd.
Fraser .Diane M; myles text book for midwives;
fifteenth edition; 2009;elesevier limited.
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