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10 - Umbilicalcord prolapse

from Section 3 - Intrapartum Emergencies

Published online by Cambridge University Press:  05 November 2012

Edwin Chandraharan
Affiliation:
St George’s University of London
Sabaratnam Arulkumaran
Affiliation:
St George’s University of London
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Summary

Cord prolapse is an obstetric emergency with a high risk of perinatal mortality. Selective transvaginal scanning in women with high-risk factors such as a transverse lie, malpresentation (e.g. footling or lexed breech) or high presenting part of fetus, may be useful. Amniotomy is contraindicated if the cord is palpable below or by the side of the presenting part during vaginal examination. Women with prelabour (prolonged) rupture of membranes (PROM) should be offered a speculum examination irrespective of the period of gestation. A digital vaginal examination indicates the presence of PROM or preterm PROM (PPROM) with cardiotocograph (CTG) abnormalities such as variable decelerations, prolonged decelerations and bradycardia and a suspicion of cord prolapse. Emergency caesarean section (CS) is frequently needed but assisted or operative vaginal delivery may be possible if the cervix is fully dilated. Post-delivery debriefing and counselling of parents and risk-management discussions are needed.
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Obstetric and Intrapartum Emergencies
A Practical Guide to Management
, pp. 68 - 77
Publisher: Cambridge University Press
Print publication year: 2012

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