Cord Prolapse or Presentation?

• Cord presentation: with or without membranes rupture, umbilical cord present between presenting part and cervix

• Cord prolapse: in the presence of ruptured membranes,

1. occult: the cord descend through the cervix alongside the presenting part
2. overt: the descent of umbilical cord past the presenting part

Upon spontaneous rupture of membranes, if liquor is clear, FHR is normal, there is no risk factors of cord prolapse, routine PV exam is not indicated.

risk factors can be:

• breech presentation or high head: like low lying placenta, abnormal
  placentation, unengaged presenting part, transverse or unstable lie
• big tummy like multiparity, polyhydramnios, twins pregnancy
• small tummy like LBW, preterm

cord compression can be reduced by:

• knee-chest, face-down position
• head down tilt (preferrable if left lateral position allowed)
• manual elevation: PV elevation of presenting part, once above pelvic brim, apply continuous upward suprapubic pressure instead, yet excessive displacement will further causing the cord to prolapse
• bladder only emptied before delivery, or even..
• if waiting for hospital transfer, filling the urinary bladder with woman in moderate trendelenburg position

source from http://www.rcog.org.uk/index.asp?PageID=2384

*give oxygen by mask at 6 L/min (=35%O2) or via Nasal cannula 4 L/min Elizabeth Davis (1981/1987). Heart & Hands: A Midwife's Guide to Pregnancy and Birth.