This document outlines the guideline details for managing a cord prolapse.

To prevent, recognise and manage cord prolapse appropriately to ensure a positive outcome for the fetus.

Cord presentation is the presence of one or more loops of umbilical cord between the fetal presenting part and the cervix, with the membranes intact.
Cord prolapse is the descent of the umbilical cord through the cervix alongside or past the presenting part in the presence of ruptured membranes.

Risk factors

General:

• Low birth weight (<2500g).
• Prematurity (<37 weeks).
• Polyhydramnios.
• Malpresentation (e.g. breech presentation, transverse/unstable lie).
• High/ill-fitting presenting part.
• Fetal congenital abnormalities.
• Multiparity.
• Second twin.
• Low lying placenta, or other placental abnormalities.

Procedure related:

• Artificial rupture of membranes.
• External cephalic version.
• Internal podalic version.
• Stabilising induction of labour.
• Applying fetal scalp electrode.
• Rotational instrumental delivery.

Considerations:

• Cord prolapse may occur without outward physical signs and with a normal fetal heart rate pattern.
• All vaginal examinations should include excluding the presence of the cord. This includes every examination in labour and after spontaneous rupture of membranes.
• Cord prolapse should be suspected where there is an abnormal fetal heart rate pattern (bradycardia, variable decelerations) particularly if such changes commence soon after membrane rupture, spontaneously or with amniotomy.
• Woman is to be reviewed by shift coordinator if junior staff unsure

CORD PROLAPSE IS AN OBSTETRIC EMERGENCY

See flow chart "Management of Cord Prolapse" Appendix 1