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Cord Prolapse
Cord prolapse complicates 0.1–0.6% of deliveries and is an obstetric emergency. Umbilical cord descends below the presenting part, causing cord compression and fetal hypoxia. Immediate action is required: relieve compression manually and expedite…
RCOG Green-top Guideline 50
The pathway
1 · Call emergency team immediately
- Shout for help: senior midwife, registrar, anaesthetist, theatre team, neonatologists
- Press emergency buzzer
- Do not leave patient
2 · Relieve cord compression
- Examiner's hand into vagina, elevate presenting part off the cord manually
- Maintain this position until delivery
- Do NOT push cord back up (vasospasm risk)
3 · Positioning
- Left lateral (Sims) position or all-fours (knee-chest) to help relieve compression
- Elevate foot of bed (Trendelenburg)
4 · Bladder filling
- Rapidly instil 500–750ml warm saline into bladder via Foley catheter — elevates presenting part
- Clamp catheter
- Do not delay theatre for this if team ready
5 · Fetal monitoring
- Continuous FHR monitoring
- Cord pulsation confirms fetal viability
- Document time of prolapse and interventions taken
6 · Delivery
- Category 1 LSCS if not fully dilated or non-vertex
- Instrumental delivery if fully dilated and vertex easily reachable
- Aim delivery within 30 min
Drugs
| Drug | Dose | Route | Notes |
|---|---|---|---|
| Warm saline | 500–750ml | Intravesical (via Foley) | Bladder filling to elevate presenting part. Clamp catheter after filling. |
| Tocolytics (terbutaline) | 250 micrograms | SC | Consider to reduce uterine contractions and decompress cord. Off-label. Senior decision. |
When to escalate
Cord pulseless — may still be viable, proceed to emergency delivery, neonatology present,Delay to theatre >30 min anticipated — maintain manual elevation continuously,Preterm (<28 weeks) — obstetric consultant, consider place of delivery, NICU,Multi-fetal pregnancy — second twin at highest risk post-first twin delivery
Reference: RCOG Green-top Guideline No. 50 (Umbilical Cord Prolapse) 2014
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