Page created on November 28, 2021. Last updated on January 17, 2022 at 18:35

Umbilical cord prolapse

Definition and epidemiology

Umbilical cord prolapse refers to when the umbilical cord prolapses before or alongside the foetus during labour, causing both to be present simultaneously in the pelvis. This is problematic because the cord will be compressed during delivery, which deprives the foetus of oxygen and nutrients, causing asphyxia. Luckily, it’s rare.

Etiology

Umbilical cord prolapse is often seen in presentation anomalies or abnormal foetal movement:

• Breech presentation
• Transverse position
• Long umbilical cord
• Polyhydramnios

Diagnosis and evaluation

There may be an abrupt change from normal CTG to one with foetal bradycardia or severe variable decelerations.

This complication is suspected based on pathological CTG as explained above, and confirmed by vaginal examination, where the cord is palpable.

Treatment

Urgent C-section is required. However, while waiting for the surgery, pressure on the umbilical cord must be relieved. This is called intrauterine resuscitation and can achieved by:

• A hand gently pushing the head away from the umbilical cord and back into the uterus
• Trendelenburg position or knees to chest position
• Tocolytics

Foetal limb prolapse

Definition and epidemiology

Foetal limb prolapse, also called compound presentation, refers to when the foetus presents with a limb first, usually an upper limb alongside the head. This is problematic because there is a high risk of dystocia (obstructed labour) or umbilical cord prolapse. It’s also rare.

Etiology

Risk factors:

• Prematurity
• Polyhydramnios
• Large pelvis compared to foetal size
• Premature rupture of membranes

Diagnosis and evaluation

Limb prolapse may be discovered incidentally during antenatal screening, or during birth, when the limb can be seen or palpated.

Treatment

Many cases of foetal limb prolapse resolve spontaneously or progress without problem. If dystocia occurs, one may gently push the limb back into the uterine cavity while simultaneously applying pressure to the uterine fundus to help descent of the foetal head. If this fails to improve the situation, C-section is necessary.