🔑 Key Learning

  • Cord prolapse is an obstetric emergency due to risk of cord compression and foetal asphyxia.
  • Descent of the cord through the cervix ahead of the presenting part.
  • Urgent management: immediate delivery (usually emergency caesarean section).
  • While awaiting delivery, relieve cord pressure by manual elevation of presenting part and maternal positioning (knee-chest or Trendelenburg).

🧬 Pathophysiology

  • The umbilical cord descends through the cervix ahead of the presenting part.
    • Compression of the cord by the foetus against the maternal pelvis compromises blood flow.
      • Leads to foetal distress, asphyxia, or death if uncorrected.
  • Affects 1 in 300 deliveries
  • Risk factors:
    • Artificial rupture of membranes (amniotomy)
    • Multiple pregnancy
    • Abnormal lie (e.g. transverse or breech presentation)

👀 Clinical Features

  • Sudden sharp abdominal pain
  • Pelvic pressure
  • Foetal distress:
    • Bradycardia
    • CTG showing variable or prolonged decelerations
  • Maternal distress:
    • Hypotension
    • Tachycardia

🩺 Examination Findings

  • Cord palpable at or beyond the cervical os on vaginal examination
  • Cord visualised externally in severe cases
  • Foetal malpresentation

💊 Management

  • Relieve cord pressure:
    • Manually elevate the presenting part
    • Position mother in knee-chest or Trendelenburg position
  • Emergency delivery
    • Emergency caesarean section is usually required

💣 Complications

  • Foetal - hypoxia, death
  • Maternal - PPH, uterine atony 

🔗 Useful Links and References