Umbilical cord prolapse

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Lucy Pettit, Midwife, Wanganui

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Umbilical cord prolapse

  1. 1. Umbilical CordProlapseLucy Pettit
  2. 2. Aims Provide information and practical guidance to enable early diagnosis and efficient initiation ofemergency procedures to ensure the best possible neonatal outcome
  3. 3. Definition  Overt prolase, the more common of the two, involves protrusion of the umbilical cord past the presenting part and into or out of the vagina
  4. 4. Definition  Occult prolapse, on the other hand, occurs when the cord descends alongside but not past the fetal presenting part; its not always palpable on digital examination. Occult prolapse can occur even when fetal membranes remain intact.
  5. 5. Objectives Identify predisposing risk factors Enable prompt diagnosis and institute immediate action Initiate correct emergency procedures Raise awareness of the neonatal implications
  6. 6. Predisposing factors Multiple pregnancy High presenting part Polyhydramnios Premature labour Malpresentations Fetal abnormalities Uterine abnormalities
  7. 7. Management Fetal survival depends on swift action Call for help – midwifery colleagues/8000 Factors to consider:  Viability of fetus  Severe fetal abnormalities Emergency delivery for a normally formed and mature fetus
  8. 8. First stage of labour Emergency LSCS  Take measures to optimise fetal well-being (maternal positioning)  Multidisciplinary approach  Teamwork
  9. 9. Second stage of labour Vaginal delivery  Depends on descent of head & rate of progress; parity Instrumental delivery  Depends on skill levels & confidence; descent of head & rate of progress.  Not a midwifery decision Caesarean section  Take measure to ensure to optimise fetal well-being  Multidisciplinary approach  Teamwork
  10. 10. Emergency procedures Elevation of the presenting part:  Digital pressure  Kneeling on all fours, buttocks uppermost, or  Exaggerated Sims (left lateral)  Fill bladder with 500mls saline  Tocolysis
  11. 11. Do’s & DontsDO DON’T Replace the cord  Replace the cord into the vagina inside the uterus Monitor the fetal  Handle the cord HR excessively Inform the woman
  12. 12. MnemonicCall for helpOrganise deliveryRelieve pressure on the cordDeliver
  13. 13. Emergency Checklist Em ergency Checklist Cord Present at ion/ Pr olapse Bradma Procedure Dat e_____________ Tim es Nam es of pr act it ioner s pr esent • Emergency Bell ……………. • 8000 obstetric emergency call made ……………. • EXAMINER performing VE protects cord from compression by ……………. remaining in position • Woman moved to knee/chest or exaggerated left lateral ……………. position • Check fetal heart rate and assess uterine activity ……………. • Commence maternal oxygen ……………. • Notify theatre of need for immediate caesarean section ……………. • Ensure Paediatrician attends main theatre ……………. • Move woman to theatre on delivery bed ……………. • Documentation ……………. Photocopy this checklist and place in patient’s notes with patient label on top of page. Use as reference for more detailed clinical notes. Remember to sign the copy for the clinical notes Please wipe clean checklist once copied and return to delivery room …………….

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