NURSING

1. CORD PROLAPSE
INTRODUCTION:-
There are 3 clinical typesof abnormal descentof the umbilical cordbythe side of the presentingpartall
of these underthe headingcordprolapse.
Occultprolapse:- The code isplacedbythe side of the presentingpartandisnot feltbythe fingerson
internal examinationitcouldbe seenonultrasonographyduringcesareansection.
Cord presentation :-Thecode isslippeddownbelow the presentingpartandis feltlyinginthe the intech
bag of membrane
Cord prolapse:- The code islyinginsidethe vaginaoroutside the vulvafollowingrupture of the
membrane.
INCIDENCE:-The incidence of code prolapse isabout1 in300 deliveries.
Incidence isreducedtowiththe the increaseduse of elective c-sectioninnoncephalicpresentation.
ETIOLOGY:-
malpresentation
contractedpelvis
prematurity
twins
hydroaminos
placental factorsminordegree placentapreviawithmarginal insertionof the cordor longcode.
Iatrogeniclowrupture of the membrane manual rotationof the headecvipvstabilizinginduction
DIAGNOSIS:-
Occultprolapse- isdifficulttodiagnose the possibilityshouldbe suspectedif thereis persistence of
variable declarationof fetal heartrate patterndetectoncontinuouselectronicfetal monitoring.

2. Cord presentationthe diagnosisismade byfellingthe pulsationof the code throughthe intact
membrane
Code prolapse the code ispalpateddirectlybythe fingerandispulsationcan be feltif the foetusisalive
code pulsation maycease duringuterine contractionwhichreturn afterthe contractionpassesoff
temptationtopull downthe loopforvisualisationforanecessaryhandlingistobe avoidedtoprevent
vasospasm.
PROGNOSIS:-
foetal- the foetusisatriskof anoxia fromthe momentcord is prolapsedthe bloodflow isoccluded
eitherdue tomechanical compressororbythe presentingpartor due to vasospasmof the umbilical
vesselsdue toexposureto coldor irritation whenexposedoutsidethe vulvaoras a resultof handling.
the hazards to the foetusismore invertex presentationif the deliveryiscompletedwithin10to 30
minutesthe foetal motilitycanbe reducedto5- 10% the overall perinatalmortalityisabout15 to50%
Maternal -the maternal riskare incidental due toemergencyoperativedeliveryspace throughthe
vaginal route operative deliveryinvolve the riskof anaesthesiabloodlossandinfection
MANAGEMENT:-
Code presentation
the aimisto preserve the membrane andtoexpedite the delivery
Once the diagnosisismade noattemptshouldbe made to replace the cord as itis notonlyineffective
but the membrane inevitable rupture leadingtoprolapse of the code.
If immediate vaginal deliveryisnotpossibleorcontraindicated caesarean sectionisthe bestmethodof
delivery.
Code prolapse managementprotocol istobe guidedby
 Baby livingordead
 Maturity of the baby
 Degree of dilatation of the cervix.
Baby living
1. DEFINITELY TREATMENT- caesareansectionisthe besttreatmentwhenthe babyissufficiently
mature and isalive. justpriorto makingthe abdominal incisionthe fetalheartsoundshouldbe
auscultatedonce more toavoidunnecessary sectiononadeadbaby operationshouldbe done
quicklyupto the deliveryof the baby.
2. IMMEDIATE SAFEVAGINALDELIVERY ispossible if the headisengageddeliveryistobe
completedbyforceps. If breechthe deliveryistobe completedbybreechextractionandin
transverse lie itshouldbe completedbyinternalversionfollowed bybreechextraction
3. IMMEDIATE SAFEVAGINALDELIVERY IS NOT POSSIBLE
firstaid management:- the aimistominimisepressureonthe cord till suchtime whenthe
patientispreparedforassisteddeliveryoristransferredtoan equippedhospital

3. if oxytocininfusionisonthisshouldbe stoppedatthistime intravenousfluidandoxygenby
maskis given.
 Bladderfeelinghasbeendone to raise the presentingpartoff the compressedcord till suchtime
that patienthas delivered.bladderisfilledwith400- 750 ml of normal saline withafoley's
catheterthe balloonisinflatedandthe catheterisclamped. bladderisemptied before
caesarean delivery.
 To liftthe presentingpartof the code by the glove fingersintroducedintothe vaginathe finger
shouldbe placedinside avaginatill definitelytreatmentisinstituted
 Postural treatmentexecutedandelevatedsimpositionwithapillow forvegunderthe hipof
thightrendelenburg orknee chestposition.
 To replace the code intothe vaginato minimise vasospasm due toirritation
Baby deadlabourisallowedtoprocessawaitingspontaneousdelivery.
MANAGMENTFLOWCHART