Cord prolapse
  • Cord coming out of vagina before baby — cord drops out of uterus before head or presenting part delivers
  • Cord may be seen at vulva, at entrance to or outside the vagina — Figure 1.37
  • Cord can be compressed between baby and pelvis during a contraction and/or spasm in colder outside temperature
    • Both stop blood supply from placenta and baby could die — aim of interventions is to take pressure off the cord

Figure 1.37   

Consider cord prolapse if

  • Woman has ruptured membranes and baby is preterm
  • Woman feels something drop out of vagina

Do not

  • Do not let woman eat or drink anything — may need operation — consider IV fluids

Check

  • Need to do vaginal exam ​to diagnose cord prolapse ​unless cord is visible outside vagina — cord is a smooth pulsating band
    • Sterile gloves best but don't delay if not available quickly
    • Handle cord as little as possible
    • Calmly tell woman what’s happening. You need her help and attention

Do — if birth about to happen

If woman has urge to push — need to birth baby quickly as baby not getting oxygen supply through cord

  • Talk woman through what is going to happen in the next few minutes
  • Ask and help woman to get into upright position — Figure 1.38 for examples
  • Encourage woman to push as hard as she can and birth baby as soon as possible — see Labour and birth

Figure 1.38   

Do — if birth not about to happen

  • Call for help
  • If cord outside vagina — use sterile gloved hand to gently put it back into vagina to keep warm
  • Ask woman to get into knee-to-chest position — Figure 1.39 OR if not able to stay in this position or ready to be transported — lie on left side with pillows or blanket under hips and head tilted down — Figure 1.40

Figure 1.39   

Figure 1.40   
  • With sterile gloved hand put 2 fingers into vagina and push baby's head (or presenting part) up off the cord — continue until baby is born
    • Get help — this is very tiring
  • Ask helper to do urgent medical consult about
    • Sending woman to hospital straight away
    • Medicines to stop labour
  • Be calm and reassure woman
  • If likely to be a long time before delivery — put in indwelling urinary catheter to help lift presenting part off cord
    • Use standard giving set to fill bladder with normal saline 500–700mL (as tolerated)
    • Clamp catheter
    • Every hour — release clamp, drain 30mL of urine and re-clamp catheter. Do more often if giving IV fluids
  • If cord stops pulsating baby may have died — medical consult