CORD PROLAPSE Flashcards
WHAT IS CORD PROLAPSE ?
CORD PRESENTING IN FRONT OF PRESENTING PART- FOLLOWING RUPTURES OF MEMBRANES.
INCIDENCE OF CORD PROLAPSE RANGES ? IS THIS FOR ALL BIRTHS?
0.1-0.6% OF ALL BIRTHS
IN THE CASE OF BREECH PRESENTATION, THE INCIDENCE OF CORD PROLAPSE IS???
1%
IS CORD PROLAPSE LIFE-THREATENING FOR THE BABY?
YES
CAN WE SEE THE CORD IN A CORD PROLAPSE?
CAN BE VISIBLE AT THE VULVA OR MAY HAVE PROLAPSED OUT OF THE VAGINA.
MAY ALSO BE DETECTABLE ON EXAMINATION OF THE VAGINA.
HOW DO WE RELIEVE CORD COMPRESSION 1/4
- MANUALLY ELEVATE THE PRESENTING PART (WITH GLOVED FINGERS).
HOW DO WE RELIEVE CORD COMPRESSION? MANUAL ELEVATION OF PRESENTING PART RATIONALE:
RELIEVES COMPRESSION PARTICULARLY DURING CONTRACTIONS
HOW DO WE RELIEVE CORD COMPRESSION 2/4
IF THE COR HAS PROLAPSED OUT OF THE VAGINA, ATTEMPT TO GENTLY REPLACE IIT BACK IN TO THE VAGINA USING A DRY PAD WITH MINIMAL HANDLING.
HOW DO WE RELIEVE CORD COMPRESSION.
RATIONALE BEHIND GENTLY REPLACING THE PROLAPSE (OUT OF VAGINA) WITH A DRY PAD 2/4
HANDING MAY CAUSE VASOSPASMS. NO EVIDENCE TO SUPPORT USING GAUZE SOAKED IN WARM SALINE.
HOW DO WE RELIEVE CORD COMPRESSION 3/4
POSITION THE WOMAN
HOW DO WE RELIEVE CORD COMPRESSION 3/4
POSITION OF WOMEN
Exaggerated Sim’s position: woman into left lateral position with head down and pillow placed under left hip
OR knee chest position
HOW DO WE RELIEVE CORD COMPRESSION 3/4
POSITION RATIONALE
MAINTAIN POSITION IN WHICH CORD COMPRESSION IS RELIEVED UNTIL THE BABY IS BORN
HOW DO WE RELIEVE CORD COMPRESSION 4/4
TRANSFER IMMEDIATELY
HOW DO WE RELIEVE CORD COMPRESSION 4/4
WHY TRANSFER IMMEDIATELY ?
DELIVERY OF THE BABY IS NEED ASAP
BLADDER-FILLING
If the decision-to-birth interval is likely to be prolonged – particularly if it involves ambulance transfer – elevation of the presenting part through bladder-filling, may be considered ONLY DO IF TRAINED TO – ALL CMW CARRY CATHETERS
RATIONALE BEHIND BLADDER FILLING
elevates the presenting part off the compressed cord for an extended time, allowing for time to transfer and freeing up a practitioner
BLADDER FILLING PROCEDURE
Insert Foley catheter into the bladder
Fill bladder via catheter with 500ml 0.9% sodium chloride, using an IV infusion set (squeeze fluid in) and clamp once 500ml has been instilled
Leave the bag of fluid attached for transfer to hospital or labour ward:
Rationale: this will remind staff to empty the bladder when the woman arrives in hospital/theatre
It is essential that the bladder is emptied before any method of delivery is attempted- detach the giving set from the catheter and let the fluid drain out
If catheter is to remain in situ for a c/s, attach a catheter bag
However, catheter should be removed if vaginal birth anticipated
Rationale: to prevent trauma
