Cord Prolapse

Cord prolapse is a critical obstetric emergency characterized by the descent of the umbilical cord through the cervix into or beyond the vagina, creating a situation where the cord becomes compressed between the presenting fetal part and the birth canal. This condition poses a significant threat to fetal well-being because the umbilical cord is the sole pathway for oxygen and nutrient transfer from the placenta to the fetus. When the cord is compressed, fetal blood flow decreases rapidly, leading to acute fetal hypoxia, metabolic acidosis, and, if not promptly corrected, stillbirth or permanent neurological injury. Cord prolapse most commonly occurs following rupture of membranes. cord prolapse can present in two major forms: overt and occult. Overt cord prolapse involves visible or palpable descent of the umbilical cord after membrane rupture, making the diagnosis straightforward. Occult cord prolapse, however, occurs when the cord lies alongside the presenting part without external visibility; it is typically suspected due to sudden fetal heart rate abnormalities, particularly profound bradycardia or recurrent variable decelerations. Funic presentation, where the cord is positioned below the presenting part prior to membrane rupture, represents a precursor state that may lead to overt prolapse if the membranes rupture spontaneously.The diagnosis of overt cord prolapse is clinical, based on identification of the cord through the cervix or at the vulva. Occult prolapse requires a high degree of suspicion and is often confirmed through vaginal examination after detection of fetal distress. Rapid recognition is crucial because fetal condition can deteriorate within minutes due to compromised blood flow. Immediate management focuses on relieving pressure from the cord to restore or maintain perfusion while expediting delivery. Recommended interventions include positioning the mother in knee-chest or steep Trendelenburg positions, manually elevating the presenting fetal part through the vagina, avoiding unnecessary handling of the cord to prevent vasospasm, and covering any exposed cord with warm sterile saline-soaked gauze. Simultaneously, preparations for emergency delivery must occur.