CORD PROLAPSE Identified
Cord palpated below/beside presenting part with ruptured membranes
All Pathways
Obstetrics & GynecologyEmergency
Umbilical Cord Prolapse Management (RCOG 2014)
Umbilical Cord Prolapse Management (RCOG 2014): CORD PROLAPSE Identified → IMMEDIATE ACTIONS - Call Emergency → Relieve Cord Compression → Patient Posit...
Pathway Overview
13 steps
Algorithm Steps
13 total
01Start 02Warning IMMEDIATE ACTIONS - Call Emergency
This is an obstetric emergency - every second counts
- CALL FOR HELP - Emergency cesarean team
- Do NOT handle cord more than necessary (prevent vasospasm)
- Continuous fetal heart rate monitoring
- Note the TIME - clock starts now
03Action Relieve Cord Compression
Elevate presenting part manually and position patient
- Insert hand into vagina
- Push presenting part UP and AWAY from cord
- Keep hand in place until delivery
- Positioning options (see next steps)
04Action Patient Positioning
Reduce pressure on cord while preparing for delivery
- KNEE-CHEST position (head down, buttocks up)
- OR Left lateral with pillow under hip
- OR Steep Trendelenburg
- Exaggerated Sims position acceptable
- Goal: Use gravity to move presenting part away from cord
05Action Cord Care
Minimize handling, keep warm and moist
- Handle cord as little as possible
- If outside vulva: cover with warm saline-soaked gauze
- Do NOT attempt to replace cord into vagina
- Keep cord warm to prevent vasospasm
06Decision Assess Cervical Dilation & Fetal Status
Determines delivery route
07Action Fully Dilated - Consider Vaginal Delivery
If delivery is imminent, may proceed vaginally
- If head on perineum: assisted vaginal delivery
- Forceps or vacuum if appropriate
- Only if faster than cesarean
- Continue elevating presenting part until delivery
- Breech: assisted breech if expertise available
08Decision Fetal Heart Rate Status
Monitor throughout - guides urgency
- If FHR present and acceptable: continue current plan
- If prolonged bradycardia: expedite delivery
- If FHR absent: confirm and discuss with parents
09Outcome Delivery Achieved
Neonatal team for immediate assessment
- Immediate neonatal resuscitation as needed
- Cord blood gases
- Document times and interventions
- Debrief with team and family
10Warning EMERGENCY CESAREAN SECTION
Category 1 (immediate) cesarean required
- Decision-to-delivery interval: aim <30 minutes
- Continue manual elevation of presenting part during transfer
- Patient to OR in position that relieves compression
- General anesthesia may be fastest
- Maintain fetal heart rate monitoring if possible
- Prepare for neonatal resuscitation
11Action Consider Tocolysis
May help if contractions worsening cord compression
- Terbutaline 0.25mg SC
- May reduce contractions and cord compression
- Use while preparing for cesarean
- NOT a substitute for urgent delivery
- Path rejoins step 08Shared downstream outcome
12Action Consider Bladder Filling
Can elevate presenting part if manual elevation difficult
- Fill bladder with 500-700mL saline via Foley
- Lifts presenting part away from cord
- Useful during transport or if delay in cesarean
- Empty bladder prior to cesarean
- Path rejoins step 08Shared downstream outcome
13Action Risk Factors (Prevention)
Be vigilant in high-risk situations
- Malpresentation (breech, transverse)
- Polyhydramnios
- Preterm labor
- Multiple gestation
- Amniotomy with high presenting part
- Artificial rupture of membranes
Guideline Source
RCOG Green-top Guideline No. 50: Umbilical Cord Prolapse
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Cord prolapse requires immediate action - seconds matter
- Decision-to-delivery interval should be <30 minutes if possible
- May occur in out-of-hospital settings with limited resources
- Management depends on cervical dilation and fetal viability
Applicable Regions
USEUUKGlobal
UK: Based on RCOG Green-top Guideline
US: Similar principles apply; ACOG endorses rapid delivery
Version 1Next review: 2027-01-01
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Related Resources
Frequently Asked Questions
What is the Umbilical Cord Prolapse Management (RCOG 2014)?
The Umbilical Cord Prolapse Management (RCOG 2014) is a emergency clinical algorithm for Obstetrics & Gynecology. It provides a structured decision tree to guide clinical decision-making, based on RCOG Green-top Guideline No. 50: Umbilical Cord Prolapse.
What guideline is the Umbilical Cord Prolapse Management (RCOG 2014) based on?
This algorithm is based on RCOG Green-top Guideline No. 50: Umbilical Cord Prolapse (DOI: N/A - RCOG Green-top).
What are the limitations of the Umbilical Cord Prolapse Management (RCOG 2014)?
Known limitations include: Cord prolapse requires immediate action - seconds matter; Decision-to-delivery interval should be <30 minutes if possible; May occur in out-of-hospital settings with limited resources; Management depends on cervical dilation and fetal viability. Individual patient factors may require deviation from these recommendations.
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