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The Difficult Delivery: Umbilical Cord Prolapse

As soon as the examining hand reveals an umbilical cord, the hand is used to elevate the presenting part and reduce compression of the cord. This hand remains in the vagina until baby is delivered by emergency c-section.

Position the mother to reduce cord compression: either knee to chest position or left lateral with head down and pillow under mom’s hip. If there is a delay to the OR, or if there is persistent fetal heart rate abnormalities, consider the use of a tocolytic: Magnesium sulfate 4 grams IV over 15 minutes, then 1-4 grams/hr IV.

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Articles of Interest

Managing Umbilical Cord Emergencies

1) Keep your hand in the vagina to elevate the fetal presenting part off the cord – until the baby can be delivered, you must prevent the fetus from compressing the cord (so sit on the bed and get comfortable). 2) Place mom in knee-to-chest position and ask her to try not to push or cough. 3) Get an OBGYN STAT! Definitive management is an immediate C-section and the fetus must be elevated off of the cord until delivery. 4) DO NOT TRY TO PUSH THE CORD BACK IN.

Optimal management of umbilical cord prolapse

Umbilical cord prolapse (UCP) is an uncommon obstetric emergency that can have significant neonatal morbidity and/or mortality. It is diagnosed by seeing/palpating the prolapsed cord outside or within the vagina in addition to abnormal fetal heart rate patterns.

The Complicated Delivery: What do you do?

The cord should not be manipulated as this can induce vasospasm and subsequent fetal hypoxia

Umbilical Cord Prolapse and Other Cord Emergencies

Several maneuvers are available to attempt to relieve compression on the cord. The patient should be immediately repositioned in knee-chest position (Fig. 3), which reduces the pressure of the presenting part on the cord.

Umbilical Cord Prolapse: An Obstetric Emergency with Dire Consequences and Ways to Improve Maternal and Fetal Outcomes.

Umbilical Cord Prolapse is a rare emergency in obstetrics. It occurs in less than one percent of all live births. The umbilical cord presents outside of the uterus and this is often accompanied by fetal bradycardia and/or variable decelerations.

Resources

TeachMeObGyn

Umbilical cord prolapse is where the umbilical cord descends through the cervix, with (or before) the presenting part of the fetus. Subsequently, fetal hypoxia occurs via two main mechanisms...