Cord prolapse/presentation Flashcards
What is a cord prolapse?
The descent of the umbilical cord through the cervix, alongside or past the presenting part, when membranes are ruptured.
What is the word for alongside presenting part?
Occult
What is the word for past the presenting part?
Overt
What is a cord presentation?
The presence of umbilical cord between the fetal presenting part and the maternal cervix, with or without intact membranes.
What is the incidence of cord prolapse?
Range from 1.4 to 6.2 per 1000
What is the perinatal mortality rate?
91 per 1000
Overt cord prolapse occurs in what percentage of breech deliveries?
> 1%
What percentage does it occur in footling breech?
15%
What percentage does it occur in complete breech?
5%
What percentage does it occur in transverse lie?
20%
What are the antenatal risk factors for cord prolapse?
Non-cephalic lie, multiparty, polyhydramnios, unengaged PP, twins, low birth weight, prematurity
What are the procedural risk factors for cord prolapse?
ARM (high PP), ECV, Internal Podalic Version, stabilising IOL, Large balloon catheter IOL
What happens during a cord prolapse?
Fetal blood supply is obstructed
Why does the fetal blood supply get obstructed?
Drop in temperature and spasms of vessels, compression between bony pelvis and presenting part
What determines the level of injury for cord prolapse?
Amount of time from prolapse to birth
What can birth asphyxia cause?
HIE, cerebral palsy and death
What is the prognosis outside of the hospital?
perinatal death is 10 times more likely
What are some ways to prevent cord prolapse?
Offering ECV, PPROM inpatient care, avoid ARM if PP high
How do we diagnose cord prolapse?
Cord is visible outside the introitus or during a speculum, Cord is palpable during a VE, Abnormal fetal heart rate pattern
General Management of cord prolapse
Maternal position- Exaggerated Sims/ knee chest
Digital elevation presenting part
Bladder filling if expected delay
How much terbutaline should be given?
0.25mg SC
How do you do bladder filling?
Insert Foley catheter
Inflate balloon, and drain urine
Fill with 500mls normal saline
Switch-off flip flow valve
