Cord prolpase for undergraduate

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Undergraduate course lectures in Obstetrics &Gynecology ,Faculty of Medicine,Zagazig University ,Prepared by DR Manal Behery

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Cord prolpase for undergraduate

  1. 1. DefinitionCord Presentation: Cord in front of presenting part before the rupture of membranesCord Prolapse: Cord in front ofpresenting part after rupture of membranes
  2. 2. Cord presentation vs. Cord prolapse
  3. 3. Occult cord prolapse• Cord lying alongside the presenting part• Occult vs. presentation vs. prolapsed cord
  4. 4. IncidencePrimigravida 0.45%Multigravida 0.66% (Risk ratio 2:3)Cephalic 0.3%Frank breech 0.9%Complete breech 5%Footling 10%Shoulder 15%Contracted pelvis 4-6 times
  5. 5. CausesMalpresentation - face, brow, breech and shoulderPrematurityPolyhydramniosMultiple pregnancyLong cord (90-100 cm)PROMCPDObstetric interventions - Amniotomy, Intrauterine pressure catheter, scalp electrode, external cephalic version,
  6. 6. Dangers• Mortality rate as high as 50%• Hypoxia• Spasm of vessels• Operative trauma to suboxgenated fetus
  7. 7. DiagnosisCord pulsationsCTG showsvariable decelerations Fundal pressure causes bradycardiaMeconium stained liquor
  8. 8. US – cord loops Cord outside vulva
  9. 9. Prevention1. Do US for malpresentation and cord presentation2.FHR monitoring3.Avoid ARM in an unengaged head4.PV exam after ROM
  10. 10. ManagementLift presenting part off the cordInstruct patient NOT to pushPosition 1. Knee chest 2. Trendelenburg 3.Exaggerated position
  11. 11. Knee chest position
  12. 12. Trendelenburg position
  13. 13. Exaggerated sim’s position
  14. 14. Management (cont..)• Vulval pad• Replacement of cord• Tocolysis (ritodrine)Funic Reduction Manual replacement of cord into uterus Cord gently pushed above presenting part while other cord decompression techniques are applied
  15. 15. Stage II Labor: - Expedite delivery with episiotomy and vacuum extraction or forceps Prepare for resuscitation of the newborn.
  16. 16. Fetal Mortality Fetal Mortality• Overall - 50%• 1st stage of labour - 70%• 2nd stage of labour -30%• Neonatal death - 4%• Perinatal mortality- 20%
  17. 17. Prognosis Fetal Mortality• More with vertex than breech• More with anterior than posterior.• More in prime than multi• < 5 minutes, prognosis good, > 5 mins, damage and death.
  18. 18. THANK YOU

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