UNCONTROLLED WHEN PRINTED
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Introduction

Umbilical cord prolapse is an obstetric emergency occurring in 0.2-0.4 of births.

  • Funic presentation (umbilical cord presentation; Figure A)
    • The umbilical cord lies in front of the presenting part, the membranes are intact
  • Overt umbilical cord prolapse (Figure B)
    • The cord lies in front of the presenting part and the membranes are ruptured
  • Occult umbilical cord presentation/prolapse (Figure C)
    • the cord lies trapped beside the presenting part, rather than below it

     

Clinical Presentation

If the cord is visible at the vaginal opening after the membranes have ruptured. This should be considered in all women at high risk for cord prolapse;

  • Malpresentation
  • Low birth weight
  • Multiple gestation
  • Multiparity
  • Preterm Labour
  • Abnormally long umbilical cord
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • Delays in recognition and management are associated with significant perinatal morbidity and mortality due mainly to complications associated with preterm birth and birth asphyxia. Therefore, cord prolapse requires urgent intervention and assistance.
  • During emergency ambulance transfer, the knee–chest position is potentially unsafe, the exaggerated Sims position should be assumed (left lateral with pillow under hip).
  • Handling the cord risks continued cord compression and vasospasm.
  • Note the time of cord presentation, as the hospital will need this information.
Management
Primary Care
  • Primary Survey
  • Offer continuous support and reassurance
  • Do NOT touch the cord or push the cord back in
  • Position patient appropriately: Place the mother in a knee to chest position (Figure D) and transport in the exaggerated sims position ( Figure E) to keep fetal presenting part off the cord
  • Cover the mother with a sheet/blanket to maintain dignity and body heat.
  • Perform vital sign survey
  • Consider oxygen if indicated as per CPG
Intermediate Care (EMT / Level 2)
  • Apply cardiac monitor if trained and authorised
  • Consider pain relief
  • Consider anti-emetic
  • If birth is imminent and the mother is actively pushing, deliver the baby as soon as possible as per Childbirth clinical skill:
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 immediately as this requires immediate C-section. Provide early notification to the receiving unit to enable preparation.
Advanced Care (AP)
  • Apply cardiac monitor if trained and authorised
  • Establish vascular access
  • Consider pain relief
  • Consider anti-emetic
  • If birth is imminent and the mother is actively pushing, deliver the baby as soon as possible as per Childbirth clinical skill:
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 to emergency obstetric unit immediately as this requires immediate C-section. Provide early notification to the receiving unit to enable preparation.
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • Liaise with obstetrics unit in the metropolitan area, recording all advice on ePCR
  • Liaise with local hospitals in country areas, recording all advice given on ePCR

References
References
Key Terms & Links

figure3Figure A: Funic Presentation

figure2Figure B: Overt Prolapse

figure1Figure C: Occult Prolapse

Cord Prolapse - Figure DFigure D: Knees to Chest

Cord Prolapse - Figure EFigure E: Exaggerated Sims Position

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