Occurs when the umbilical cord comes out of the uterus with or before the presenting part of the baby

Aetiology

• Associated with malpresentation, preterm labour, 2nd twin, artificial membrane rupture

Pathophysiology

• Direct compression and cord spasm → decreased blood flow → hypoxia → death

Clinical features

• May occur with no outward physical signs and a normal foetal heart trace
• Abdominal examination - ill-fitting or non-engaged presenting part should alert one to the possibility of cord prolapse
• Vaginal examination - examine for the cord at every VE during labour and specifically after rupture of membranes if risk factors

Investigations

• Scan for foetal cardiac activity
  • With prolonged and complete compression, bradycardia occurs
  • With deteriorating foetal status, activity diminishes and eventually stops

Management

• Immediate delivery (CS or forceps)
• Tocolytic and maternal positions to relieve pressure