Chapter 67 Presentation and prolapse of the umbilical cord
Introduction
In approximately 0.1–0.6% of births, the umbilical cord descends below the presenting part (RCOG 2008). The cord vessels may become occluded by pressure of the descending presenting part, potentially resulting in irreversible brain damage, stillbirth or neonatal death. There are three variants:
Causes
Risk factors
(Dilbaz et al 2006, Kahana et al 2004, RCOG 2008, Sheiner et al 2004).
Diagnosis
Vaginal examination may reveal a cord presentation, the cord being palpated through the fetal membranes. Pulsation, synchronous with the fetal heart, may be felt. If the presenting part is high, the cord may float away from the examining fingers. Uterine arterial pulsation will be felt in the vaginal fornices, synchronous with the maternal pulse. Therefore, the midwife should auscultate the fetal heart and simultaneously take the maternal pulse if she is unsure of the source of pulsation. If a cord presentation is suspected, the midwife must aim to keep the membranes intact and should attempt to reduce any cord compression by placing the mother in an exaggerated Sims’ position with the hips and buttocks elevated by a wedge or pillows (Squire 2002) (Fig. 67.3). Medical assistance should be called at once and the midwife must stay with the woman. Elevating the maternal pelvis may encourage the umbilical cord to move, but if the cord presentation persists, the fetus will be delivered by caesarean section.
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