[CG] Cord prolapse, immediate management (viable fetus)

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Definition:

A loop of cord present below or alongside the presenting part in the presence of ruptured membranes.

Immediate Management in Maternity Assessment:

  • Call for assistance – “Emergency page” 2222 – Obstetric, Anaesthetic and neonatal staff for obstetric theatre – to prepare for immediate delivery (vaginal or caesarean section).
  • Inform Labour ward coordinator. Transfer to theatre (confirm with coordinator which theatre prior to transfer) as soon as possible.

Prior to transfer:

  • Keep hand in vagina and elevate the presenting part of the fetus above the pelvic inlet to relieve cord compression.
  • Avoid handling cord.
  • This manoeuvre should be maintained during transfer to Labour Ward.

ALTERNATIVES:

  1. Insert a Foley catheter into the bladder. Fill bladder with 500mls normal saline via a giving set. Clamp catheter and attach drainage bag and transfer to theatre. Ensure theatre staff aware of need to empty bladder PRIOR to starting procedure.
  2. Knee - Chest position or left lateral and elevation of foot of bed (take care when transfer of patient in this position)

THE FOLLOWING SHOULD BE PERFORMED AS SOON AS POSSIBLE (EITHER IN MATERNITY ASSESSMENT OR ON ARRIVAL IN LABOUR WARD – BUT DO NOT DELAY TRANSFER):

  1. Vaginal examination to confirm diagnosis & ascertain cervical dilatation.
  2. Auscultation of fetal heart.
  3. IV access.
  4. G & S.

See full Cord Prolapse Management guideline for further management options in theatre.

Last reviewed: 06 December 2016

Next review: 31 January 2021

Author(s): Julie Murphy

Version: 2

Approved By: Obstetrics Clinical Governance Group