ODOBGYNDECODED
Emergency Hub / Birth emergency

⚡ Cord Prolapse

IN REVIEWPENDING CLINICAL VERIFICATIONTIME-CRITICAL PROTOCOLFull clinical topic →
1 RECOGNIZE
  • Cord visible/palpable below or alongside the presenting part after membrane rupture, or sudden prolonged fetal bradycardia where prolapse is possible.
  • Assess fetal heart rate and whether vaginal birth can be safely accomplished immediately; avoid unnecessary handling of the cord.
2 CALL FOR HELP
  • Declare cord prolapse, call senior obstetrician, anaesthetist, theatre and neonatal team; state fetal heart status and time of diagnosis.
3 IMMEDIATE ACTION
  1. Immediately elevate the presenting part OFF the cord with a gloved hand and keep relieving compression until birth or a reliable alternative is established. Position the mother knee–chest or exaggerated left lateral with head down as appropriate.
  2. Minimise cord handling; do not repeatedly attempt to push the cord above the presenting part. Stop oxytocin.
  3. If transfer/delay is likely, bladder filling can maintain elevation: insert a Foley catheter, instil 500–750 mL saline through the catheter and clamp. This is bladder instillation, NOT an IV fluid dose. Empty the bladder before birth.
  4. Arrange urgent birth: category-1 caesarean with abnormal fetal heart rate unless vaginal birth is imminent and safely achievable. Do not delay birth to complete manoeuvres, tests or transfer paperwork.
4 INVESTIGATIONS (never delaying treatment)
  • Continuous fetal heart assessment when practical; document the response to decompression. Investigations must not delay birth.
5 DEFINITIVE MANAGEMENT
  1. Maintain decompression through transfer/anaesthetic preparation; transfer with an appropriately skilled person when manual elevation is needed.
  2. If full dilatation and rapid safe vaginal birth is possible, the senior operator selects it; otherwise expedite caesarean according to fetal condition.
  3. Tocolysis may be considered by the obstetric team when abnormal fetal heart rate persists and birth is delayed, but must not replace decompression or delay birth.
6 ESCALATION
  • Persistent fetal bradycardia: immediate senior operative birth and neonatal resuscitation readiness.
7 POST-EVENT CARE
  • Cord gases and neonatal assessment; evaluate encephalopathy/cooling eligibility if indicated.
  • Document compression-relief measures, fetal heart changes and decision/birth times; debrief mother/family.

Admission & discharge after the acute event

Care setting: Immediate hospital obstetric emergency

Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.

When admission or continued hospital care is needed

  • Urgent birth and neonatal support are needed according to fetal viability/status and the obstetric situation.

When clinic, day care or home care may be suitable

  • Cord prolapse requires emergency maternity care, not observation at home.

Before going home

  • After birth apply the actual delivery/operation recovery criteria. Review bleeding, pain, urinary function and any anaesthetic complications.
  • The neonatal team has documented the baby’s condition, any resuscitation/injury concerns and follow-up.

Discharge medicines and treatment changes

  • Use the postnatal/operative prescription for the care actually delivered; the cord prolapse itself does not define a routine home drug course.

Tests, pending results and their reviewer

  • Complete the birth/resuscitation record and assign outstanding maternal or neonatal results.

Home care and counselling

  • Offer an explanation and debrief, psychological support and a written record of events.

Follow-up: when and what to review

WhenAction / responsible service
Before discharge
Agree maternal wound/trauma review and neonatal follow-up if needed.
Routine postnatal contacts
Review physical and emotional recovery and concerns about future pregnancy.

Return urgently

  • Maternal heavy bleeding, fever, chest symptoms or severe pain and any newborn deterioration require urgent care.

Open the complete discharge checklist →

Sources for this plan:
RCOG · Patient informationcheckedNICE · NG192checkedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarychecked

Sources

RCOGcheckedRCOG · Patient informationcheckedNICE · NG192checkedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedRCOG · Current public recovery informationcheckedNICE · CG50, recommendationschecked