im 40 weeks pregnant and head still not engaged. midwife mentioned a cord prolapse but said it was very rare.?

Question

does any1 have any info about this??

Answer 1

Okay so you don't need to know any more than you might need a section. Do not go looking on the internet and scaring yourself to death, just plan in your head that you need a section and discuss it with the consultant when you see them.

Answer 2

Umbilical Cord Prolapse
What is the umbilical cord?
The umbilical cord is a flexible, tube-like structure that, during pregnancy, connects the fetus to the mother. The umbilical cord is the baby’s lifeline to the mother. It transports nutrients to the baby and also carries away the baby’s waste products. It is made up of three blood vessels – two arteries and one vein.

What is umbilical cord prolapse?
Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. In a prolapse, the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. The cord can then become trapped against the baby’s body during delivery. Umbilical cord prolapse occurs in approximately one in every 300 births.

What causes an umbilical cord prolapse?
The most common cause of an umbilical cord prolapse is a premature rupture of the membranes that contain the amniotic fluid. Other causes include:

Premature delivery of the baby
Delivering more than one baby per pregnancy (twins, triplets, etc.)
Excessive amniotic fluid
Breech delivery (the baby comes through the birth canal feet first)
An umbilical cord that is longer than usual
What are the consequences of umbilical cord prolapse?
An umbilical cord prolapse presents a great danger to the fetus. During the delivery, the fetus can put stress on the cord. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.

How is an umbilical cord prolapse detected?
The doctor can diagnose a prolapsed umbilical cord in several ways. During delivery, the doctor will use a fetal heart monitor to measure the baby’s heart rate. If the umbilical cord has prolapsed, the baby may have bradycardia (a heart rate of less than 120 beats per minute). The doctor can also conduct a pelvic examination and may see the prolapsed cord, or palpate (feel) the cord with his or her fingers.

How is an umbilical cord prolapse managed?
Because of the risk of lack of oxygen to the fetus, an umbilical cord prolapse must be dealt with immediately. If the doctor finds a prolapsed cord, he or she can move the fetus away from the cord in order to reduce the risk of oxygen loss.

In some cases, the baby will have to be delivered immediately by cesarean section. If the problem with the prolapsed cord can be solved immediately, there may be no permanent injury. However, the longer the delay, the greater the chance of problems (such as brain damage or death) for the baby.

Answer 3

Your midwife should not be scaring the life out of you like that; if she suspected a cord prolapse, she would have got you in to hospital at once. Sometimes the baby's head does not engage properly until about half an hour before delivery!

If the cord was prolapsed, it could be very hazardous for your baby, requiring ab emergency c-section. Maybe the midwife was thinking aloud. Keep a note of your baby's kicks; if you feel your baby has gone very quiet, you should go to hospital.

Answer 4

with my last child(#10) my baby girls cord was prolapsed i had a very good obstetrician and he called in a specialist it was a very good thing that he did because not only was the cord prolapsed but it was also wrapped around her neck 3 times. because the cord was prolapsed i had to have an emergency c-section. the c-section saved my baby girls life. prolapsed cord is very serious and no disrespect to your mid-wife(im a midwife also)seek the assistance of a good obstetrician because if the cord is prolapsed you have to have a c-secion i almost found out to late(i was in labor)

Answer 5

Prolapsed Cord
Three varieties:1

Overt cord prolapse - if the presenting part of the fetus does not fit the pelvis snugly after membrane rupture, there is a risk that the umbilical cord can slip past and present at the cervix or descend into the vagina. This is known as overt cord prolapse. It represents an acute obstetric emergency as prolapse exposes the cord to intermittent compression compromising the fetal circulation. Depending on its duration and degree of compression, fetal hypoxia, brain damage and even death can occur. Exposure of umbilical cord to air causes irritation and cooling producing vasospasm of the cord vessels.
Occult cord prolapse - where the umbilical cord lies alongside the presenting part.
Funic presentation - where the cord can be felt to prolapse below the presenting part before membranes have ruptured. The cord may slip to one side of the head and disappear as the membranes rupture.
Epidemiology
Incidence
Overall incidence approximately 3/1000 deliveries.2
Overt cord prolapse occurs in:

0.5% cephalic and frank breech presentations
5% complete breech
15% footling breech
20% transverse lie
Incidence of occult prolapse unknown but 50% of monitored labours show fetal heart rate changes suggesting umbilical cord compression, which is usually transitory and relieved by changing mother's position.

Risk factors3
Multiparity
Prematurity (less than 34 weeks gestation)
Abnormal presentations - footling breech is particularly risky
Cephalopelvic disproportion
Pelvic tumours, placenta praevia, low lying placenta
Polyhydramnios
Macrosomia
Multiple birth
High fetal station
Long umbilical cord
Obstetric interventions including amniotomy (before presenting part is engaged), use of scalp electrode or intrauterine pressure catheter and attempted external cephalic version4
Presentation
Signs
An ill-fitting or non-engaged presenting part should alert one to the possibility of cord prolapse.
Fetal monitoring - Whilst the fetus remains in good condition, variable fetal heart rate deceleration are seen during uterine contractions that promptly return to normal after contraction subsides. With prolonged and complete compression bradycardia occurs. With deteriorating fetal status activity diminishes and eventually stops. Any fetal bradycardia or decelerations that may indicate compression of a prolapsed cord should be confirmed/ruled out with a vaginal examination.
Diagnosis:

Overt - cord can be seen protruding from the introitus or loops of cord can be palpated within the vaginal canal. If the cord is pulsating, the fetus is alive.
Occult - rarely felt on pelvic examination and only indication may be fetal heart rate changes.
Funic presentation - loops of cord are palpated through the membrane.
Investigations5
Loops of cord in front of the presenting of the presenting part can be visualized using colour Doppler studies. This is not routinely done but can be used to serially examine women at high risk.

Management6 7
Treat prolapsed cord as an emergency.

Overt - if fetus viable, place mother in knee-chest position (patient facing the bed, chest level to bed, knees tucked under chest, pelvis and buttocks elevated) and apply upward pressure against presenting part to lift fetus away from prolapsed cord whilst proceeding to emergency caesarean section as soon as possible.
If available give salbutamol 0.5mg IV slowly over 2 minutes to reduce contractions. Only proceed with vaginal delivery if delivery is imminent, the cervix is fully dilated and there are no contraindications. This can be expedited with episiotomy/vacuum extraction or forceps.
Ensure resuscitation available for baby post-delivery.
If the fetus has died, deliver in the manner that is safest for the woman.
Occult (if suspected) - place mother in left lateral position. If fetal heart rate returns to normal, allow labour to continue with mother receiving O2 and fetal heart rate continuously monitored. Otherwise rapid caesarean section.
Funic presentation - A decision should be made between prompt elective caesarean section prior to membrane rupture or artificial rupture of membranes with full preparations for an emergency caesarian section in case the cord does become an overt prolapse on rupture.
Prognosis
Up to 20% perinatal mortality with all cases of overt prolapse with prematurity and congenital abnormality being the underlying factor in many cases4 8 .

Prevention
Treat high-risk patients with constant fetal monitoring during delivery.
Do not artificially rupture membranes if presenting part is high.

Answer 6

Nothing to do with the head not being engaged.
http://www.bbc.co.uk/health/ask_the_doctor/prolapsedumbilicalcord.shtml
http://www.pregnancy-bliss.co.uk/cordprolapse.html