Occurs when the umbiical cord comes out of the uterus with or before the presenting part of the baby
Aetiology
- Associated with malpresentation, preterm labour, 2nd twin, artificial membrane rupture
Pathophysiology
- Direct compression and cord spasm → decreased blood flow → hypoxia → death
Clinical presentation
- May occur with no outward physical signs and a normal fetal heart trace
- Abdominal examination - ill-fitting or non-engaged presenting part should alert one to the possibility of cord prolapse
- Vaginal examination - examine for the cord at every VE during labour and specifically after rupture of membranes if risk factors
Investigations
- Scan for fetal cardiac activity
- With prolonged and complete compression, bradycardia occurs
- With deteriorating fetal status, activity diminishes and eventually stops
Management
- Immediate delivery (CS or forceps)
- Tocolytic and maternal positions to relieve pressure
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