Undergraduate course lectures in Obstetrics &Gynecology ,Faculty of Medicine,Zagazig University ,Prepared by DR Manal Behery

2. Definition
Cord Presentation: Cord in front of
presenting part before the rupture of
membranes
Cord Prolapse: Cord in front of
presenting part after rupture of
membranes

4. Cord presentation vs. Cord prolapse

5. Occult cord prolapse
• Cord lying alongside the presenting part
• Occult vs. presentation vs. prolapsed cord

6. Incidence
Primigravida 0.45%
Multigravida 0.66% (Risk ratio
2:3)
Cephalic 0.3%
Frank breech 0.9%
Complete breech 5%
Footling 10%
Shoulder 15%
Contracted pelvis 4-6 times

7. Causes
Malpresentation - face, brow, breech and shoulder
Prematurity
Polyhydramnios
Multiple pregnancy
Long cord (90-100 cm)
PROM
CPD
Obstetric interventions - Amniotomy, Intrauterine
pressure catheter, scalp electrode, external cephalic
version,

8. Dangers
• Mortality rate as high as 50%
• Hypoxia
• Spasm of vessels
• Operative trauma to suboxgenated
fetus

9. Diagnosis
Cord pulsations
CTG shows
variable decelerations
 Fundal pressure
causes bradycardia
Meconium stained
liquor

10. US – cord loops Cord outside
vulva

11. Prevention
1. Do US for malpresentation and cord
presentation
2.FHR monitoring
3.Avoid ARM in an unengaged head
4.PV exam after ROM

12. Management
Lift presenting part off the cord
Instruct patient NOT to push
Position
1. Knee chest
2. Trendelenburg
3.Exaggerated position

13. Knee chest position

14. Trendelenburg position

15. Exaggerated sim’s position

16. Management (cont..)
• Vulval pad
• Replacement of cord
• Tocolysis (ritodrine)
Funic Reduction
Manual replacement of cord into uterus
Cord gently pushed above presenting
part while other cord decompression
techniques are applied

17. Stage II Labor:
 - Expedite delivery with episiotomy and
vacuum extraction or forceps
 Prepare for resuscitation of the newborn.

18. Fetal Mortality
Fetal Mortality
• Overall - 50%
• 1st stage of labour - 70%
• 2nd stage of labour -30%
• Neonatal death - 4%
• Perinatal mortality- 20%

19. Prognosis
Fetal Mortality
• More with vertex than breech
• More with anterior than posterior.
• More in prime than multi
• < 5 minutes, prognosis good, > 5 mins,
damage and death.

20. THANK YOU