Synopsis
Detect cord prolapse promptly, protect umbilical blood flow during emergency preparation and transfer, and select an appropriate urgent route of birth.
- Overt prolapse passes beyond the presenting part; occult prolapse lies alongside it after membrane rupture.
- Cord presentation means the cord lies between the presenting part and cervix, with membranes intact or ruptured.
- Use minimal handling of the cord to reduce vasospasm.
- Elevate the presenting part manually or by bladder filling while preparing birth.
- Do not attempt to replace the cord above the presenting part to continue labour.
- An abnormal fetal heart pattern usually requires category-one caesarean unless vaginal birth is immediately achievable.
- Continue decompression throughout transfer and empty a filled bladder before delivery.
Key red flags
Sudden bradycardia or recurrent variable decelerations beginning after membrane rupture demand examination for prolapse.
A visible or palpable cord below the presenting part establishes the emergency even if the fetal trace is initially normal.
A high or mobile presenting part, non-cephalic lie or a second twin increases concern following ruptured membranes.
Investigation priorities
Confirm prolapse and assess whether immediate vaginal birth is possible.
Management branches
A prolapsed cord is identified while the fetus remains undelivered.
- Activate the maternity emergency response and tell the team explicitly that cord prolapse is present.
- With a gloved hand, gently elevate the presenting part to relieve cord pressure; minimise direct handling of exposed cord loops.
- Stop oxytocin and use a knee–chest position or left lateral position with the head lowered as feasible.
- Maintain decompression while another clinician assesses fetal condition, cervical dilatation and the fastest safe birth route.
Key medicines
Terbutaline as a temporising adjunctRCOG suggests 250 micrograms subcutaneously when tocolysis is chosen; reassess maternal and fetal response while urgent delivery preparations proceed.Use only with appropriate obstetric supervision and maternal monitoring. Consider tachyarrhythmia, cardiac disease, hyperglycaemia and hypokalaemia risk; it must not replace decompression or delay definitive birth.