Umbilical cord prolapse

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Cord prolapse is an obstetric emergency during pregnancy or labour that endangers the life of the fetus. It occurs when the umbilical cord presents itself outside of the uterus while the fetus is still inside. It can happen when the water breaks – with the gush of water the cord comes along. Usually, thereafter the fetus will engage and squash the cord, cutting off oxygen supplies and leading to brain damage of the fetus, or stillbirth. Before that happens, the baby must be delivered quickly by caesarean section. In the meantime, the woman adopts the knee-elbow position, and an attendant reaches into the vagina and pushes the presenting part (usually the head) back in so that it does not suffocate the cord. It is useless to try to push the cord back in. Another technique is to infuse 500ml of fluid by catheter into the mother's bladder, in order to displace the presenting part upward, and to reduce compression on the prolapsed cord.

Risk Factors

Potential predisposing risk factors include:

Natural History, Complications and Prognosis

The mortality rate for the fetus is given as 11-17%[1]. This applies to hospital births or very quick transfers in a first world environment. One series is reported where there was no mortality in 24 cases with the novel intervention of infusing 500ml of fluid by catheter into the bladder, in order to displace the presenting part upward and reduce compression on the prolapsed cord.

Treatment

Contraindicated medications

Umbilical cord prolapse is considered an absolute contraindication to the use of the following medications:

Surgery

Some practitioners will attempt to reduce pressure on the cord and deliver vaginally right away. Frequently the attempt to resolve the prolapsed cord and deliver the baby vaginally fails, and an emergency caesarean section must be performed immediately.[2] While the patient is being prepared for a caesarean, the woman is placed in the Trendelenburg position or the knee-elbow position,[3] and an attendant reaches into the vagina and pushes the presenting part out of the pelvic inlet and back into the pelvis to remove the pressure from the umbilical cord.[4] If attempts to deliver the baby promptly fail, the fetus' oxygen and blood supply are occluded and brain damage or death will occur.

References




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