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Cord prolapse - Coggle Diagram
Cord prolapse
Risk Factors
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Unstable lie: the presentation of the fetus changes between transverse/oblique/breech and back (can consider admission if gestation >37weeks due to increased risk)
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Management
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Manually elevate the presenting part off the cord by vaginal digital examination. Alternatively, if in the community, fill the maternal bladder with 500ml of normal saline (warmed if possible) via a urinary catheter and arrange immediate hospital transfer.
Encourage into left lateral position with head down and pillow placed under left hip OR knee-chest position. This will relieve pressure off the cord from the presenting part
Consider tocolysis (e.g. terbutaline) – if delivery is not imminently available this will relax the uterus and stop contractions, relieving pressure off the cord. It may be sufficient to allow enough time for transfer to a location where delivery is feasible (e.g. an operating theatre for a Caesarean section). This is a particularly useful strategy if there are fetal heart rate abnormalities while preparing for a C-section.
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Clinical features
Considered in the presence of a non-reassuring foetal heart rate pattern (declarations, bradycardia) and absent membranes
Considered in the presence of bleeding per vagina or heavily blood stained liquor with ruptured membranes. This would suggest placental abruption (the placenta starts to separate from the uterine wall) or vasa praevia (fetal vessels running in the fetal membranes adjacent to the internal os of the cervix).
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Definition: The umbilical cord descends through the cervix, with (or before) the presenting part of the fetus
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