Umbilical cord prolapse
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[1]
- Low birth weight
- Multiparity
- Fetal malpresentation
Clinical Features
- Presentation of ubmilical 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
Diagnosis
- Clinical diagnosis
Management
- Emergent OB/Gyn consult
- Do NOT attempt to reduce cord - instead, elevate the 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 pt is in OR
- Place pt in knee-chest position and encourage not to push or cough[1]
Disposition
- Admit to L&D