تدلي الحبل السري

Definition

Cord prolapse is descent of the cord ahead of the fetus after membrane rupture, compressing it and cutting off fetal perfusion.

Risk factors

Non-cephalic presentation (breech, transverse), polyhydramnios, prematurity, twins and rupture with a high presenting part.

Signs

• Sudden fetal bradycardia or variable decelerations after rupture
• The cord seen or felt in the vagina

Immediate actions

• Call for help
• Manually elevate the presenting part off the cord until delivery
• Knee-chest or Trendelenburg position
• Maternal oxygen and stop oxytocin
• Minimal cord handling, no attempt to replace it; cover with warm moist gauze if external
• Urgent delivery, usually caesarean

Exam point

After any rupture of membranes, check the fetal heart immediately.