Prolapsed Umbilical Cord Flashcards
Descent of the umbilical cord into the vagina before the presenting part
Prolapsed umbilical cord
When do the prolapsed umbilical cord happen
anytime after the membranes rupture (especially if the presenting part isn’t fitted firmly in the cervix)
is an emergency requiring prompt action to save the fetus
Prolapsed Umbilical cord
In this problem the cord may become compressed between the fetus and the maternal cervix or
pelvis thus comprimising
fetoplacental perfusion
This happens when the collapsed cord is outside due to change in temperature or manual handling
Drying
atrophy of the umbilical vessels
cord vasospasm
Causes
Cephalopelvic disproportion preventing firm engagement
Factors interfering with fetal descent (High station)
Fetal presentation other than cephalic
Hydramnios
Intrauterine tumors preventing the presenting part from engaging
Multiple gestation
Placenta previa
Premature rupture of membranes
Small or preterm fetus
Assessment
Cord possibly palpable at the perineum during vaginal examination or visible at the vulva
Fetal heart rate (FHR) showing variable or prolonged decelerations
Test result
Ultrasonography confirms a prolapse
Treatment
Measures to relieve pressure on the cord are initiated immediately.
Trendelenburg (if cord isn’t palpated in posterior cervical area)
Knee-chest position (if evidence demonstrates uterus hasn’t ruptured) to cause the fetal presenting part to fall back from the cord.
A sterile gloved hand may be inserted into the vagina to elevate the fetal head up and off the cord.
Treatments (2)
Oxygen, usually
Continuous FHR monitoring (if not already in place), with frequent observations for decelerations
Saline-soaked sterile dressings over any exposed portion of the cord
Vaginal delivery if the patient’s cervix is fully dilated; cesarean delivery if cervical dilation is incomplete
Variations of prolapsed Cord
Occult (Hidden) Prolapse
Cord Prolapse in front of the fetal head
Complete cord prolapse
The cord is compressed between the fetal presenting part and pelvis but cannot be seen or felt during vaginal examination
Occult (Hidden) Prolapse
The cord cannot be seen but can probably be felt as a pulsating mass during vaginal examination
Cord Prolapse in front of the fetal head
The cord can be seen protruding from the vagina
Complete cord prolapse
Prompt actions reduce cord compression and increase fetal oxygenation:
- Position the woman’s hips higher than her head to shift the fetal presenting part toward her diaphragm. Any of these methods may be used:
a. Knee-chest position
b. Trendelenburg position
c. Hips elevated with pillows, with side-lying position maintained - Maintain vaginal elevation of the presenting part using a gloved hand while the woman is transferred to the operating room (OR) until the physician orders cessation of vaginal elevation, usually just before cesarean birth. Minimize cord compression from the hand that is elevating the presenting part as much as possible during the woman’s transport to the OR.
- Avoid or minimize manual palpation or handling of the cord as much as possible to minimize cord vessel vasospasm.
- Ultrasound examination may be used to confirm presence of fetal heart activity before cesarean delivery.
