Concept:

• Cord presentation refers to the condition of cord slipping down below the presenting part in the intact bag of membranes.
• It is identified by pulsation in the intact membrane.
• Management:
  • Do not replace the cord as it can lead to rupture of membrane.
  • Immadiate vaginal delivery. If vaginal delivery is not possible, cesaren section is performed.
  • While preparing for cesarean section, women is kept in exaggerated Sim's position or traditionally used trendelenburg or knee-chest position. Trendelenburg can be tirsome for the patient.

Explanation:

• The positioning is done to minimize cord compression.
• Cord prolapse is different from the cord presentation.
• Cord prolapse refers to the cord lying inside or outside the vulva following rupture of membranes.
• First aid management for cord prolapse:
  • Minimize the pressure on the cord.
  • Bladder is filled with 400-750ml of normal saline to raise the presenting part off the compressed cord.
  • Presenting part is lifted off the cord by gloved fingers.
  • Exgaggerated and elevated Sim's position with a pillow under thigh. Trendeleburg or knee-chest position has been traditionally used.
  • Replace the cord to minimize vasospasm due to irritation.