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Cord prolapse is an obstetric emergency during pregnancy or labour that endangers the life of the baby. It is when the umbilical cord presents itself outside of the uterus while the fetus is still inside. It can happen when the water breaks – with the gush of water the cord comes along. Usually, thereafter the fetus will engage and squash the cord, cutting off oxygen supplies and leading to brain damage or stillbirth. Before that happens, the baby must be quickly delivered by caesarean section. In the meantime, the woman should adopt the knee-elbow position, and an attendant reach into the vagina and push the presenting part (usually the head) back in so that it does not suffocate the cord. It is useless to try to push the cord back.
Potential predisposing risk factors include:
- Premature rupture of the amniotic sac
- polyhydramnios (having too much amniotic fluid) the cord may be forced out with the more forceful gush of waters
- long umbilical cord
The mortality rate for the fetus is given as 11-17%. This applies to hospital births or very quick transfers in a first world environment. One series is reported where there was no mortality in 24 cases with the novel intervention of infusing 500ml of fluid by catheter into the bladder, in order to displace the presenting part upward and reduce compression on the prolapsed cord.
References and notes
- ^ http://www.gpnotebook.co.uk/simplepage.cfm?ID=1785397303 GP Notebook. Mortality 11-17%.