OTHER COMPLICATIONS

Umbilical Cord Prolapse

Cord prolapse is rare; it occurs in only 0.4% of cephalic term pregnancies. Abnormal presentations such as a complete breech or transverse lie carry a higher risk with an incidence of up to 6% and greater than 20%, respectively. The diagnosis may be suspected when there is a sudden fall in FHR, especially on rupturing the membranes in a patient with a known abnormal fetal lie or a patient with polyhydramnios. The diagnosis is confirmed by palpation of the umbilical cord on vaginal examination, with or without an associated fetal bradycardia. Management consists of manual replacement of the cord and avoidance of cord compression by the presenting fetal part against the pelvic rim. Urgent cesarean section should be performed. A regional technique may be considered if an epidural catheter is already in situ or if a spinal technique can be expeditiously performed in the lateral position. In the event that fetal compromise is noted, general anesthesia is usually chosen.