UMBILICAL CORD PROLAPSE

Umbilical cord prolapse is the prolapse of the umbilical cord of the baby into the vagina during delivery. The cord can sometimes come out. If the leading part of the baby is the head, the cord hangs far enough to get in front of the head. The same situation can be seen in babies who come with breech presentation. Membranes must be opened so that the cord hangs over the birth path. If the cord is palpated in front of the baby before the dice are opened, it is called cord presentation. Umbilical cord prolapse is a rare condition and occurs in less than 1% of pregnancies.
Cord prolapse occurs in the presence of ruptured membranes, and is either occult or overt:
Occult (incomplete) cord prolapse: the umbilical cord descends alongside the presenting part, but not beyond it.
Overt (complete) cord prolapse:  the umbilical cord descends past the presenting part and is lower than the presenting part in the pelvis.
Cord presentation : the presence of the umbilical cord between the presenting part and the cervix. This can occur with or without intact membranes.
Risk factors for umbilical cord prolapse:
- Malpresentation (umbilical cord prolapse is most common at transverse presentation and later at breech presentation)
- Polyhydramnios
- The cord is longer than normal
- Preterm delivery
- Low birth weight
- Twin, triplet pregnancies
- EMR, PPROM
- Fetal anomalies
- Grand multiparite (having more than 5 births)
- Insertion of the intrauterine pressure catheter
- Amnioinfusion
Umbilical cord prolapseusually occurs suddenly when the membranes are opened, or sometimes prolapse may occur at a later time. It is often not possible to understand that the cord will prolapse before the dice open. Sometimes it may be doubtful that the umbilical cord is seen on the front side in ultrasonography. Sometimes the first finding that causes suspicion may be impaired heart rate of the fetus in NST.
Treatment:
It is not possible to push the prolapsed cord back into the uterus in case the cord prolapses. Umbilical cord prolapse is a risky condition because the leading cord portion can become pinched, causing the fetus to experience severe distress. Therefore, it is often necessary to give birth in the normal way immediately if there is enough clearance to be born immediately, otherwise delivery by cesarean.


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