Umbilical cord prolapse: Difference between revisions
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==Background== | ==Background== | ||
*Occurs in 0.5% of pregnancies | |||
*Likely secondary to the presenting fetal part not filling enough of the lower uterus and allowing cord to present first during labor.<ref name="Mercado">Mercado J, Brea I, Mendez B, et al. Critical obstetric and gynecologic procedures in the emergency department. Emerg Med Clin North Am. 2013 Feb;31(1):207-36.</ref> | |||
===Risk factors=== | |||
**Low birth weight<ref name="Mercado" /> | |||
**Multiparity<ref name="Mercado" /> | |||
**Fetal malpresentation<ref name="Mercado" /> | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:Cord.prolaps.jpg|thumb|Umbilical cord prolapse cord in the vaginal canal (red arrow).]] | |||
*Presentation of umbilical cord before fetal delivery (can be felt as pulsatile structure on exam) | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Emergency delivery DDX}} | {{Emergency delivery DDX}} | ||
== | ==Evaluation== | ||
*Clinical diagnosis | |||
==Management== | ==Management== | ||
*Do NOT attempt to reduce | [[File:Position Knee Chest.jpg|thumb|Image of knee-chest position.]] | ||
*Emergent OB/Gyn consult | |||
*Do NOT attempt to reduce cord | |||
*Elevate presenting fetal part to reduce compression and transport to OR for emergent C-section<ref>Holbrook BD. Umbilical cord prolapse. Obstet Gynecol Clin North Am. 2013 Mar;40(1):1-14.</ref> | |||
**Examiner who diagnosed umbilical cord prolapse must maintain umbilical decompression until patient is in OR | |||
*Place patient in knee-chest position and encourage not to push or cough<ref name="Mercado" /> | |||
**May also consider Trendelenburg position (if patient can tolerate) to let gravity assist in moving fetus off pelvic floor | |||
==Disposition== | ==Disposition== | ||
*Admit to L&D | |||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:OBGYN]] | |||
Latest revision as of 20:49, 11 December 2024
Background
- Occurs in 0.5% of pregnancies
- Likely secondary to the presenting fetal part not filling enough of the lower uterus and allowing cord to present first during labor.[1]
Risk factors
Clinical Features
- Presentation of umbilical cord before fetal delivery (can be felt as pulsatile structure on exam)
Differential Diagnosis
- Emergent delivery
- Umbilical cord prolapse
- Breech delivery
- Shoulder dystocia
- Perimortem cesarean delivery
Evaluation
- Clinical diagnosis
Management
- Emergent OB/Gyn consult
- Do NOT attempt to reduce cord
- Elevate presenting fetal part to reduce compression and transport to OR for emergent C-section[2]
- Examiner who diagnosed umbilical cord prolapse must maintain umbilical decompression until patient is in OR
- Place patient in knee-chest position and encourage not to push or cough[1]
- May also consider Trendelenburg position (if patient can tolerate) to let gravity assist in moving fetus off pelvic floor
Disposition
- Admit to L&D