Cord prolapse Flashcards
what is it
Descent of the cord through the cervix below the presenting part after ROM
Why is it an emergency
Emergency as cord compression and vasospasm from exposure of the cord causes fetal asphyxia
what are risk factors for cord prolapse
- 2nd twin
- Footling breach
- Prematurity
- Polyhydramnios
- Unengaged head
- Transverse/unstable lie
- Male
When should CS definitely be the mode of delivery?
if cord presentation is noted prior to membrane rupture
How does cord prolapse present?
- obvious if cord at introitus
- fetal bradycardia
- variable fetal heart decelerations
How should cord prolapse be managed
- keep cord in vagina
- minimal handling of cord to prevent spasms
- displace presenting part by putting hand in vagina and push it back up during contractions
- knee to chest position so bottom higher than head
- tocolysis to reduce contractions and help bradycardia (terbutaline SC)
- DELIVER FETUS ASAP
What is the mode of delivery for cord prolapse?
LSCS or instrumental ASAP if fully dilated
if fully dilated and presenting part is low in pelvis - ventouse/forceps if leading to <15min delivery
How is hypoxic brain injury that may have resulted from delivery excluded?
paired cord blood samples for pH and base excess