umbilical cord accidents Flashcards
occult prolaps
cord lies beside the presenting part
frank prolapse
cord below the presenting part with the membranes ruptured; may or may not be preceded by cord presentation, where the cord is below the presenting part by the membranes are still intact
which presentation has the highest rates of cord prolapse?
breech
risk factors for cord prolapse
malpresentation (mc) multiple pg malformations and prematurity polyhydramnios placenta previa fibroids congenital malformations of the uterus uterine laxity contracted pelvis AROM intrauterine manipulation
what steps need to be taken during AROM to assess cord prolapse?
auscultate heart tones during, after, and through the next few UCs
palpate on vaginal exam to establish that presenting part is now well engaged with no prolapse
check for color of fluid, clear or meconium stained, age of meconium, particulate or homogenous
do AROM in reclined position to bring presenting part downward
how to dx cord prolapse
vaginal exam
FHT abnormalities (early or variable decels)
pressure to the uterine fundus—>drop in FHT
when do you need to do a vaginal exam immediately after ROM?
breech, multiple pg, unstable lie, high presenting part, polyhydramnios, or onset of fetal distress
when should you not perform AROM?
if the presenting part is not fitting well into the lower uterine segment
treatment for prolapsed cord
immediate delivery usually by c-section
place pt in knee-chest position
push up presenting part to relieve pressure on the cord
oxygen by mask to mom
monitor FHTs and transport
if cervix is dilated and you can deliver immediately, you can consider
etiology of cord entanglement
long cord excess fluid combo of the above two freedom of fetal movement common in monoamniotic twins (2 cords, 1 sac)
complications of entanglement
compromise to umbilical blood flow if cord is tight
variable decels
APGAR may be lower
failure of descent of head
two types of short cord
Absolute -
complications of short cord
fetal distress fetal death placental abruption breech presentation delayed onset of labor occasionally cord rupture
etiology of knotting
accidentally due to fetal activity
complications of knotting
fetal distress
1 minute APGARs are lower
perinatal death rate increased 5x
