Cord Prolapse Flashcards
Definiton
Decent of umbilical cord through the cervix either alongside or past the presenting part in presence of ruptured membranes.
*TIME CRITICAL EMERGENCY*
Incidence
0-1% - 0.6% of all births, in breech it is 1%.
Antenatal Risk factors
- Breech presentation
- Multiparity
- Fetal congenital abnormality
- Unstable lie
- Malpresentation
- Polyhydroamnios
- ECV
- Low birth weight <2500g
Intrapartum Risk factors
- ARM
- Uengaged PP
- Prematurity
- Breech presentation
- Second twin
- FSE application as pushes head up
Diagnosis
SEE IT - Cord may be visible outside of vagina
FEEL IT - Cord pulsation and uneven surface under membrane
HEAR IT - Variable decals/Bradycardia
If suspected perform VE or Speculum, Cx dilation, descent and potential for vaginal delivery changes management
Help
SOAPS
Senior midwife - Aware of ward activity and get theatres ready
Senior OBS - Manage delivery
Anaesthetist - In case we need to go theatre
Paediatrician - Assess baby condition
Scribe
Runner
Principle management
*Relive pressure on cord*
- Maternal pressure
- Bladder filling
- Tocolysis
- IV access and bloods
Maternal Position
- Knee chest
- Exaggerated SIMS (Left lateral with pillows under hips)
- Trendelburg (Head down and feet in air)
Continue EFM until delivery, feel cord, listen and OB will check with USS
Management if fully dilated Cx
Expedite birth in quickest way, encourage maternal pushing, consider Epis, prepare for instrumental delivery quickly.
Management if not fully dilated Cx
- Continue elevating PP, knee chest position
- Consider tocolysis as contractions compresses cord
- Avoid stimulation to avoid vasospasm
- Minimal handling to avoid reactive vasoconstriction and fetal hypoxic acidosis
DELIVER BY C/S AT EARLIEST
Bladder filling (Recommended if long decision to delivery interval expected e.g home birth/community)
To elevate PP
- 16GA Foley catheter
- Attach end of blood giving set to catheter
- Fill bladder 500-700mls normal saline
- Clamp catheter and encamp before C/S
If No pulsation/No FHH
- Scan to be performed by observations
- 2 obs to confirm FDIU
Documentation
- Use pro forma
- Time of cord prolapse
- Time help arrived and called
- Methods used to alleviate cord compression
- Staff present
- Time of decision to assist birth
- Method and time of birth
- Condition of baby
- Incident forms
Aftercare
Maternal
- Routine post labour/post operative Obs
- Psychological care
Neonatal
- Resuscitation
- Early feed
- Skin to skin
- Cord gases
- Vit K
- Delayed cord compression if baby in compromised
Complications
Neonatal mortality and morbidity
Hypoxic brain injury
