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Department of Reproductive Health and Research (RHR), World Health Organization

Managing Complications in Pregnancy and Childbirth

A guide for midwives and doctors 


Section 2 - Symptoms

Prolapsed cord


  • The umbilical cord lies in the birth canal below the fetal presenting part.

  • The umbilical cord is visible at the vagina following rupture of the membranes.


  • Give oxygen at 4–6 L per minute by mask or nasal cannulae.



If the cord is pulsating, the fetus is alive.

  • Diagnose stage of labour by an immediate vaginal examination (Table C-8). 

  • If the woman is in the first stage of labour, in all cases: 

- Wearing high-level disinfected gloves, insert a hand into the vagina and push the presenting part up to decrease pressure on the cord and dislodge the presenting part from the pelvis;

- Place the other hand on the abdomen in the suprapubic region to keep the presenting part out of the pelvis;

- Once the presenting part is firmly held above the pelvic brim, remove the other hand from the vagina. Keep the hand on the abdomen until caesarean section;

- If available, give salbutamol 0.5 mg IV slowly over 2 minutes to reduce contractions;

- Perform immediate caesarean section.

• If the woman is in the second stage of labour:

- Expedite delivery with episiotomy  and vacuum extraction  or forceps;

- If breech presentation, perform breech extraction  and apply Piper or long forceps to the after-coming head;

- Prepare for resuscitation of the newborn.


If the cord is not pulsating, the fetus is dead. Deliver in the manner that is safest for the woman.


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Clinical principles

Rapid initial assessment

Talking with women and their families

Emotional and psychological support


General care principles

Clinical use of blood, blood products and replacement fluids

Antibiotic therapy

Anaesthesia and analgesia

Operative care principles

Normal Labour and childbirth

Newborn care principles

Provider and community linkages



Vaginal bleeding in early pregnancy

Vaginal bleeding in later pregnancy and labour

Vaginal bleeding after childbirth

Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure

Unsatisfactory progress of Labour

Malpositions and malpresentations

Shoulder dystocia

Labour with an overdistended uterus

Labour with a scarred uterus

Fetal distress in Labour

Prolapsed cord

Fever during pregnancy and labour

Fever after childbirth

Abdominal pain in early pregnancy

Abdominal pain in later pregnancy and after childbirth

Difficulty in breathing

Loss of fetal movements

Prelabour rupture of membranes

Immediate newborn conditions or problems


Paracervical block

Pudendal block

Local anaesthesia for caesaran section

Spinal (subarachnoid) anaesthesia


External version

Induction and augmentation of labour

Vacuum extraction

Forceps delivery

Caesarean section


Craniotomy and craniocentesis

Dilatation and curettage

Manual vacuum aspiration

Culdocentesis and colpotomy


Manual removal of placenta

Repair of cervical tears

Repair of vaginal and perinetal tears

Correcting uterine inversion

Repair of ruptured uterus

Uterine and utero-ovarian artery ligation

Postpartum hysterectomy

Salpingectomy for ectopic pregnancuy



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