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 umbilical cord before fetal delivery (can be felt as pulsatile structure on exam)

Differential Diagnosis

Evaluation
  • 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 patient is in OR
  • Place patient in knee-chest position and encourage not to push or cough[1]

Disposition
  • Admit to L&D

See Also

References
  1. Mercado J, Brea I, Mendez B, et al. Critical obstetric and gynecologic procedures in the emergency department. Emerg Med Clin North Am. 2013 Feb;31(1):207-36.
  2. Holbrook BD. Umbilical cord prolapse. Obstet Gynecol Clin North Am. 2013 Mar;40(1):1-14.
This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.