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List risk factors for umbilical cord prolapse.
Recognize and manage umbilical cord prolapse.
Participate in constructive team debriefing after cord prolapse.
Umbilical cord prolapse is a condition in which the umbilical cord presents ahead of the presenting part of the fetus. The umbilical cord will typically protrude into the cervix, vagina, or outside of the body. Cord prolapse is considered an obstetric emergency because of the risk of complications including cord compression, umbilical artery vasospasm, and umbilical vein obstruction, all of which lead to the risk of fetal oxygenation compromise.
Unengaged presenting part due to maternal or fetal factors
Fetal malpresentation
Footling breech—15% risk of cord prolapse
Complete breech—5% risk of cord prolapse
Frank breech—0.5% risk of cord prolapse (which is equivalent to cephalic)
Prematurity
Low birth weight
Second twin
Fetal anomalies
Polyhydramnios
Long umbilical cord
Low lying placenta
Maternal pelvic deformities
Uterine tumors or malformations
Multiparity
Artificial rupture of membranes with an unengaged presenting part
Cervical ripening with a balloon catheter
Induction of labor
Application of an internal scalp electrode
Insertion of an intrauterine pressure catheter
Manual rotation of the fetal head
Amnioinfusion
External cephalic version
Internal podalic version
Application of forceps or vacuum
Avoid unnecessary obstetric interventions and perform necessary interventions with care
Awareness of patients at high risk is key to enable prompt diagnosis and management if prolapse occurs
Patient with antepartum diagnosis of funic presentation should be followed closely until time of delivery. Funic presentation will resolve in many patients with the onset of labor
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