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Cord Prolapse

Cord Prolapse: Cord prolapse is the condition where the umbilical cord lies below the presenting part after rupture of membranes.

 

In cord presentation, the membranes are intact.

 

In occult cord prolapse the cord is by the side of the presenting part, but not felt by the examining fingers.

 

Cord prolapse occurs more commonly in flexed / complete breech or in case of footling presentation because engagement in both cases occur late whereas in frank breech chances are less because engagement occurs early.

 

Frank breech

Complete breech (Flexed breech)

• Most common in primigravida

• Engagement occurs early

• Less chances of cord prolapse

• Most common in multipara

• Engagement occurs late

• More chances of cord prolapse


Also Know:

 

Factors associated with cord prolapse -

 

Mnemonic-

 

MTP contraindicated in Heart patients.

 

M - Malpresentations - commonest being transverse lie followed by breech presentation [Footling> flexed (complete) > Frank breech]

 

T - Twins - specially incase of second twin

 

P - Prematurity

 

Contraindicated - Contracted pelvis

 

In - Iatrogenic viz - low rupture of membranes, manual rotation of head with versions.

 

Heart - Hydraminos with membrane ruptrue.

 

Patient - Placental factors viz minor degree of placenta previa with marginal insertion of cord, battle dare placenta or long cord.
 

Extra Edge:

 

In case of cord prolapse, on CTG variable deceleration is seen.

Algorithm

Management of Cord prolapse

Baby alive and viable

Baby dead

Vaginal delivery not imminent

Confirm by USG

Cesarean section

Await spontaneous labour

 

Vaginal delivery imminent

 

 

Vertex

Breech

 

 

Forceps / Vacuum

Breech Extraction

 

(At full dilatation and a suitable station, forceps is faster than LSCS in delivering the baby) do not consider fetal height.





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