Cord Prolapse: The Daily PANCE Blueprint
Which of the following is the management of cord prolapse causing prolonged bradycardia in fetal heart rate tracings?
A. Normal vaginal delivery
B. Emergent cesarean section
C. Watchful waiting
D. IV steroids and IV magnesium
E. Uterus evacuation (D&C)
Answer and topic summary
The answer is B. Emergent cesarean section
Umbilical cord prolapse is a rare but serious condition when the umbilical cord drops/prolapses. The prolapse can be overt or non-overt. In overt prolapse, the umbilical cord falls ahead of the fetal presenting part and essentially prolapses into the vagina or cervical canal. Non-overt is when the cord slips alongside (not ahead). Risk factors include preterm labor, polyhydramnios, multiple gestations, PROM, and breech presentation. The first sign is typically prolonged fetal bradycardia or mod-severe variable decelerations or late decelerations. For the majority of patients, management is emergent cesarean birth to avoid fetal compromise.
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