View source for Umbilical cord prolapse

==Background==
*Occurs in 0.5% of pregnancies
*Likely secondary to the presenting fetal part not filling enough of the lower uterus and allowing cord to present first during labor.<ref name="Mercado">Mercado J, Brea I, Mendez B, et al. Critical obstetric and gynecologic procedures in the emergency department. Emerg Med Clin North Am. 2013 Feb;31(1):207-36.</ref>

===Risk factors===
**Low birth weight<ref name="Mercado" />
**Multiparity<ref name="Mercado" />
**Fetal malpresentation<ref name="Mercado" />

==Clinical Features==
[[File:Cord.prolaps.jpg|thumb|Umbilical cord prolapse cord in the vaginal canal (red arrow).]]
*Presentation of umbilical cord before fetal delivery (can be felt as pulsatile structure on exam)

==Differential Diagnosis==
{{Emergency delivery DDX}}

==Evaluation==
*Clinical diagnosis

==Management==
[[File:Position Knee Chest.jpg|thumb|Image of knee-chest position.]]
*Emergent OB/Gyn consult
*Do NOT attempt to reduce cord
*Elevate presenting fetal part to reduce compression and transport to OR for emergent C-section<ref>Holbrook BD. Umbilical cord prolapse. Obstet Gynecol Clin North Am. 2013 Mar;40(1):1-14.</ref>
**Examiner who diagnosed umbilical cord prolapse must maintain umbilical decompression until patient is in OR
*Place patient in knee-chest position and encourage not to push or cough<ref name="Mercado" />
**May also consider Trendelenburg position (if patient can tolerate) to let gravity assist in moving fetus off pelvic floor

==Disposition==
*Admit to L&D

==See Also==
*[[Emergent delivery]]

==External Links==

==References==
<references/>

[[Category:OBGYN]]