4.2 - Cord prolapse - Exam Flashcards
Exam: Describe the potential causes of cord prolapse
Presenting part of the fetus not fitting into the maternal pelvic inlet (e.g. small preterm baby or twin; especially the second twin, transverse lie, malpresentation such as footling or flexed breech, and polyhydramnios).
Grande multiparity,
maternal pelvic abnormalities,
relatively long cord
or low placental implantations
and male fetuses [Reference Lin1–3].
Obstetric interventions such as amniotomy, stabilising induction,
insertion of a supracervical balloon catheter for induction of labour,
placement of internal monitoring devices,
external cephalic version (ECV) and internal podalic version
Intrapartum spontaneous rupture of membranes with advanced cervical dilation
high presenting part of fetus.
birth weight <2500 grams
Polyhydramnios
preterm delivery
preterm PROM
malpresentation
Exam: Discuss how to identify and manage cord prolapse
- visual inspection
- paplation during VE where the cord is felt below or beside the presenting part
- Abnormal FHR pattern - bradycardia, severe variable declareations occuring soon after spont or arm of membranes
https://www.youtube.com/watch?v=URa1sI4y43o
Exam: video
https://www.youtube.com/watch?v=bpyVV8Gusic
https://www.youtube.com/watch?v=URa1sI4y43o
Exam: How would you define ‘cord prolapse?
Cord presentation - the presence of umbilical cord between the presenting part of the fetus and the cervix and membranes are intact
Cord prolapse - the umbilical cord lies in front or beside the presenting part in the presence of ruptured of membranes
in both conditions a loop of cord is below the presenting part
the difference is in the condition of the membranes (if intact it is cord presentation, if ruptured it is cord prolapse)
Exam: What are the 2 types?
*** Occult: **
* If the cord is lying alongside the presenting
*** Overt: **
* If the cord is below the presenting part and in the vagina or outside vulval introitus
Exam: How does cord prolapse differ from cord presentation?
- Umbilical cord presentation: the umbilical cord lies in front of the presenting part, the membranes are intact.
- Umbilical cord prolapse: the cord lies in front of the presenting part and the membranes are ruptured
- Occult umbilical cord presentation/ prolapse: the cord lies trapped beside the presenting part,
- Overt
- Below the present part
Exam: Are there any preventative measures that can be undertaken to reduce the risk of cord prolapse?
- Identification/awareness of risk factors
- ARM should not be done when the station is high
- if fetal head is high
- abnormal fetal presentation
- cord felt when completing a VE
*
Exam: How is it diagnosed?
CTG: prolongs deceleration as a early sign followed by increased severity of FH decelerations, prolonged bradycardia
* early decelerations as indicator of occult cord presentation
VE: cord presentation
visual of cord with spectum
* improvement in decelerations between contractions or/and if Maternal position changed
* Common changes in FHR: tachycardia, prolonged deceleration,
ongoing bradycardia.
* VE fundings depends on degree of prolapse/
cord presentation, e.g. palpated/seen on visual inspection/rarely
felt/protruding from introitus/palpated loops
Exam: What is the aim of management of cord prolapse?
- Call for help - code green and code pink
- Leave hand in place and lift presenting part off the cord Manual displacement of presenting part to avoid cord compression
- Place mother in Low Trendelenburg position
(head lower than legs) on the left side with pillows inserted under the hip or on all fours - push cord back into uterus
- Utilisation of warm packs to keep cord insitu and not affected by temperature to avoid vasaspasm of the umibical cord
- exaggerated sim’s position
- Filling of bladder with 500 - 750 ml NS to move presenting part away from cervix
- IV access
- Terbutaline if contracting,
- cease synt if running
- Oxygen administration
- post delivery -cord bloods
- consider IVABS to reduce risk of infection
- Debrief with team
- debrief and education with the family
*
Exam: How would you care for a woman who has experienced a cord prolapse? How would that differ in
a low resource setting with no theatre available?
- call in obygn team and aranged for transport if not fully dilated
- if a long delay in delivery
- urinary bladder filled with fluid to elevate the presenting part off the compressed cord
- avoid over-handling of the umib cord
- administer o2
- Consider turbutaline in contracting
- midwife/ob escort
- resus equipment
- Delivery equipment
- PPH manangement
- continous CTG monitoring
- if fully dilated undertake an assisted vaginal birth, presenting part at spines or below
- Head down bum up
*
Exam: How did the management of the case in the video differ from what you have read? Can you think
of why this may differ? Is this an error or a reasonable variation?
- debrief mother and team involved
- liase with SCN if baby is being monitored ?hypoxic injury
- organise regular training for staff
- Consider IV anti’s
- identify causative factors in anticipation of future pregnancies
Exam: Identify the landmarks of the presenting part and the diameter.
- dilalition
- lie of fetus
- fetal head - pelvic station via ve in relation to ischial spines
*
Terbutaline
IV Injection:
250 microg (0.5 mL) as a single dose.
Subcutaneous Injection
(if no IV access): 250 microg (0.5 mL) as a single dose.
https://www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-MPs/Terbutaline.pdf?thn=0
