Umbilical cord prolapse Flashcards
What is cord presentation?
This is when the umbilical cord lies beside or below the presenting part but with the membranes still intact
What is cord prolapse?
This is when the umbilical cord lies beside or below the presenting part with the membranes ruptured
The cord can be in the cervical os, the vagina, or the introitus
What are the maternal causes of umbilical cord prolapse?
- Cephalopelvic disproportion
- High presenting part during labour
- Grand multiparity
What are the foetal causes of umbilical cord prolapse?
- Polyhydroamnios
- Placentae praviae
- Multiple pregnancy
- Abnormal lie-breech or transverse
How do we diagnose cord prolapse?
It is usually felt when we do a vaginal examination or even if there are sudden fetal heart rate abnormalities following the rupture of membranes
-auscultation of the fetal heart rate is necessary then
What is the management for cord presentation?
C/s
What is the management of cord prolapse?
- Immediate delivery
2. Or c/s
How should’ve we approach the birth if the baby is alive and viable but has a cord prolapse?
- Replace the cord in the vagina or wrap with warm, wet towel
- Elevate the presenting part to relieve the compression
- Confirm fetal viability by ausculating for the heart rate
- Take the patient to theatre immediately
What should we do at delivery for a patient with cord prolapse?
- Do c/s if there are contra-indications to doing a vaginal exam
- Administer oxygen by mask
- Initiate tocolytic to stop the contractions-nifedipine or salbutamol
- Position the patient in knee chest position (trendelenburg position)-if NVD
- With c/s we need to understand we are trying to save the baby
- Prepare for foetal resus
Why do we need to make sure we cover the umbilical cord with a warm, wet cloth?
If it is dry it causes vasospam
