Management of cord prolapse

The aim of the management in the few minutes it takes to perform a caesarian section is to prevent the compression of the cord by the presenting part. Thus:

• determine if the cord is still pulsating
  
  
• if the cord is pulsating then push any exposed loop back into the vagina so to keep it warm and moist
  
  
• displacement of the presenting part, in particular during a contraction, by putting a hand in the vagina, so that the presenting part does not compress the cord
  
  
• positioning the woman such that gravity tends to keep the presenting part off the cord, i.e. knee-elbow position
  
  
• infusion of fluid, e.g. 500 ml saline, into the bladder, via a size 16 catheter
  
  
• keeping the cord in the vagina and avoiding handling in order to prevent spasm

Note: If the presenting part is sufficiently low in the pelvis and the cervix is fully dilated then an experienced obstetrician might undertake a vaginal delivery (forceps if cephalic presentation or breech extraction). Otherwise an immediate caesarian section is indicated.