Review Note

Last Update: 03/27/2025 09:33 PM

Current Deck: ACG Part 2::Obstetrics

New Card (Unpublished)

Currently Published Content

Front

Back

No published tags.

Pending Suggestions

Field Change Suggestions:

Front

Commit #309762

SS_OB 1.34 Discuss the anaesthetic management of problems that may arise with labour and delivery, including the following situations:
- COrd prolapse

Back

Commit #309762

Cord prolapse

Defined as the descent of the umbilical cord through the cervix alongside (occult) or past the presenting part (overt) in the presence of ruptured membranes.

Cord presentation – presence of the umbilical cord between fetal presenting part and cervix, with or without membrane rupture.

Incidence 0.1-0.6%.

Risk factors
General

Multiparity

Low birth weight (<2.5kg)

Prematurity (<37/40)

Fetal congenital anomalies

Breech presentation

Transverse, oblique and unstable lie

Second twin

Polyhydramnios

Low-lying placenta, other abnormal placentation.

Procedure related

Artificial rupture of membranes

Vaginal manipulation of fetus with ruptured membranes

ECV.

Clinical features

Should be suspected when there is an abnormal fetal HR pattern (bradycardia, variable decelerations), particularly if such changes commence soon after membrane rupture, spontaneously or with amniotomy.

Obstetric management

Call for assistance

Immediate delivery in theatre by LSCS to prevent hypoxia-acidosis (Cat 1).

Minimal handling of loops of cord lying outside vagina to prevent vasospasm.

Presenting part should be elevated manually, mother adopting knee-chest position or head-down tilt to prevent cord compression.

Anaesthetic management

Cat 1 LSCS for suspicious or pathological fetal HR but without unduly risking maternal safety.

Cat 2 LSCS for women in whom fetal HR is normal.

Prepare for quick onset of anaesthesia – GA vs neuraxial depending on if the cord is decompressed and whether the fetus is compromised.

Practitioner competent in resus of newborn should attend all deliveries with cord prolapse.

ROCG – Umbilical cord prolapse.