Cord Prolapse Flashcards
What do you suspect has happened
Cord prolapse
What factors led you to this conclusion
Polyhydramnios and unstable lie
SROM
Call for assistance
Emergency buzzer - summon help
Request :
Obstetric emergency - 2222
Emergency trolley
Emergency telephone call :
Obstetrician
Paediatrician
Anaesthetist
Senior charge midwife
Any other available staff
Remember to remain with woman at all time
SBAR
Situation - this is jean, she has had a cord prolapse
Background - para 4 at 37 weeks gestation
Polyhydramnios and unstable lie during pregnancy.
Attended day care clinic due to RFM
SROM
Assessment - clear liqor draining, fetal heart 90bpm on auscultation
On inspection cord is visible
Recommendation
Require immediate delivery of baby
Either vaginal or emergency section depending on findings of VE
Relieve pressure of cord
Manually relieve pressure off cord ;
This allows perfusion and therefore blood flow and oxygen supply to the Fetus.
How to relieve pressure:
Insert two fingers into posterior part of vagina with consent
Manually push presenting part off the cord
Careful to minimise touching/ handling of the cord to prevent cord spasm - would reduce blood flow through cord.
Prevent it being to exposed can also cause cord spasm.
Observer cord to ensure it is still pulsating- this shows the Fetus is still viable
Assess cervix
Determine is delivery is imminent or not and confirm presenting part. (Vertex or breech).
Assess cervical dilatation:
If fully dilated and delivery imminent - could proceed to vaginal delivery.
If vaginal delivery not imminent transfer to theatre for cat 1 EMLUCS
Further measures
If delivery not happening immediately for exactly if the woman was being transferred by ambulance .
- insert catheter, secure with balloon
-Bladder filled with 500-700mls warm saline.
Wrap cord:
The cord could be careful wrapped with warm packs to prevent it becoming cold and spasming
Tocolytic agent
If uterine activity is present a tocolytic agent should be administered to arrest contractions.
0.25mg terbutaline administered subcut.
Positions
A number or positions can help to further relieve the pressure off the cord.
Knee-chest position -
On all course, bring knees up to chest and pelvis and buttocks elevated.
Use elbows to suppose and position head to the side.
Use gravity to further relieve pressure of presenting part off cord.
Exaggerated sums position
Onto left lateral, with a pillow under the hip to elevate the hips.
Bring right leg up towards chest and bend.
Trendelenburg position
Remove any excess pillows from the bed and lie the bed flat.
Place a pillow under right to prevent aortocaval compression.
Move bed out from the wall, lower top end of bed so the women is lying tilted.
Manually elevates presenting part and relieves pressure off cord.
Used if manual positions cannot be done
Cannulation
Cannulate - gain venous access to obtain bloods and administer fluids and drugs.
2x wide bore canullas (14 or 16 gauge)
Aseptic non touch technique with consent, sterile dressing applied.
Bloods:
Full blood count
Group and save
Transfer to theatre - MOVE
move acronym to transfer patient
Monitor - full set of obs.
Auscultation of fetal heart prior to transfer to theatre ensure viable Fetus.
Transferred on bed - ensure safety for woman and midwife on bed relieving pressure off cord. Ensure a clear path to theatre.
Oxygen - fetal compromise, not maternal so shouldn’t be required.
If woman did, portable oxygen would be required.
Venous access - 2 wide bore cannulas due to operative delivery.
Expertise - 2222 call request obstetrician and paediatrician in attendance.
Require correct staff in theatre.
Antacid
Once arrived in theatre due to emergency caesarean section under ga, antacid should be administered to neutralise any acid in the stomach and reduce risk of aspirating.
Administer - ranitidine 50mg iv
Sodium citrate - 30ml oraly
Drugs should be checked and verified by two staff members prior to administration
Check drug, dose, route and expiry date.
Should be prescribed by a doctor.
Pre operative checklist
Identification band present and correct
Caps, crowns, loose teeth
Denture removed
Prosthetics removed
Glasses/ contact lenses removef
Jewellery and body piercings removed
Make up and nail polish removed
Tampons and underwear removed
Case notes and drug cardex
Fasting regulations
Any tubes in situ eg catheter
Bloods taken for group and save
Urine voided
Any known allergies
Pre operative care
Maternal observations - full set of obs performed and documented.
Skin preparation - pubic area shaved if required.
Theatre hat - woman should have theatre hat on.
Ensure the following have been done
Full set of obs
Consent for EMLUCS
IV access
Bloods taken and sent
Catheterisation
Abacus’s
Pre op checklist
Checked allergies
Paeds present
Catheterisation
Should be done immediately before delivery.
Size 12 indwelling Foley’s with catheter bag.
Aseptic non touch technique with consent.
Remember to take care minimising touch with cord to prevent spasm.
Auscultation
Auscultation of fetal heart - immediately prior to knife to skin, the fetal heart should be auscultated to ensure there is still a viable fetus.
If no fetal heart head then caesarean would not be performed.
Cord blood gases should be obtained following birth to ascertain oxygenation to the Fetus during the cord prolapse and determine wether there has been acidosis
