cord prolapse and presentation BY ANUSHRI SRIVASTAVA.pptx

Abnormal descent of the umbilical cord by the side of the presenting part. (HEADING CORD PROLAPSE , HCP)
Cord Prolapse are of three types-
OCCULT PROLAPSE
FUNIC PRESENTATION
CORD PROLAPSE
OCCULT PROLAPSE-Cord placed by the side of the presenting part, not felt by the fingers on internal examination but seen in USG and CS
CORD PRESENTATION- Cord is slipped down below the presenting part and felt lying in the intact bag of membranes
CORD PROLAPSE- Cord Lying inside the vagina or outside vulva following rupture of membranes.

INCIDENCE
Cephalic Presentation – 0.5%
Transverse Lie- 20%
Commonly confined to parous women
ETIOLOGY
Malpresentation
Transverse
Breech
Compound
Contracted pelvis
Prematurity
Twins
Hydramnios
Placental factor- minor degree placenta Previa with marginal insertion of the cord or long cord
Iatrogenic
Procedure related
Low Rupture of Membrane
Manual Rotation of Head
Version
Stabilizing induction
DIAGNOSIS
OCCULT CORD PROLAPSE
Bradycardia on continuous electronic foetal monitoring
Intrapartum USG informative
CORD PRESENTATION
Feel the pulsation of cord through intact membranes
CORD PROLAPSE
By fingers
Pulsation if foetus is alive
PREVENTION AND EARLY DETECTION
USG- to know fetal lie and cord position
ARM avoided until the presenting part is well applied to the cervix.
Pelvic examination
Needing of the membranes and slow release of amniotic fluid until the presenting part is fixed against the cervix
MANAGEMENT OF CORD PRESENTATION
Once the diagnosis is made, no attempt should be made to replace the cord
If immediate NVD is not possible, CS is best method of delivery (Sims Position)

RARE OCCASION-
When foetus with longitudinal lie, good uterine contractions, cervix nearly full dilated and without any evidence of foetal distress-
1. left lateral maternal position
2. Oxygen Administration
3. Electronic foetal Monitoring
4. Forceps delivery/ Cs is done
MANAGEMENT OF CORD PROLAPSE
BABY ALIVE
1. Immediate CS (Treatment Of Choice)
2. Immediate Safe NVD possible with Normal CTG
BABY DEAD
Confirm with USG
Wait for Spontaneous Delivery
THANKYOU

1. CORD PROLAPSE AND PRESENTATION BY ; ANUSHRI SRIVASTAV CLINICAL INSTRUCTOR

2. INTRODUCTION Abnormal descent of the umbilical cord by the side of the presenting part. (HEADING CORD PROLAPSE , HCP)

3. TYPES Cord Prolapse are of three types- OCCULT PROLAPSE FUNIC PRESENTATION CORD PROLAPSE

4. 1. OCCULT PROLAPSE Cord placed by the side of the presenting part, not felt by the fingers on internal examination but seen in USG and CS

5. Cord is slipped down below the presenting part and felt lying in the intact bag of membranes

6. CORD PROLAPSE Cord Lying inside the vagina or outside vulva following rupture of membranes.

7. INCIDENCE Cephalic Presentation – 0.5% Transverse Lie- 20% Commonly confined to parous women

8. Malpresentation Transverse Breech Compound Contracted pelvis Prematurity Twins Hydramnios

9. Placental factor- minor degree placenta Previa with marginal insertion of the cord or long cord Iatrogenic Procedure related Low Rupture of Membrane Manual Rotation of Head Version Stabilizing induction

10. OCCULT CORD PROLAPSE Bradycardia on continuous electronic foetal monitoring Intrapartum USG informative CORD PRESENTATION Feel the pulsation of cord through intact membranes CORD PROLAPSE By fingers Pulsation if foetus is alive

11. PREVENTION AND EARLY DETECTION USG- to know fetal lie and cord position ARM avoided until the presenting part is well applied to the cervix. Pelvic examination Needing of the membranes and slow release of amniotic fluid until the presenting part is fixed against the cervix.

12. MANAGEMENT CORD PRESENTATION Once the diagnosis is made, no attempt should be made to replace the cord If immediate NVD is not possible, CS is best method of delivery (Sims Position)

13. CORD PRESENTATION RARE OCCASION- When foetus with longitudinal lie, good uterine contractions, cervix nearly full dilated and without any evidence of foetal distress- 1. left lateral maternal position 2. Oxygen Administration 3. Electronic foetal Monitoring 4. Forceps delivery / Cs is done

14. MANAGEMENT OF CORD PROLAPSE