Cord prolapse occurs when the umbilical cord descends through the cervix alongside or past the presenting fetal part. It has an incidence of 0.2% of births and can result in high rates of fetal death from asphyxia. Risk factors include breech presentation, multiple gestation, and premature rupture of membranes. Management involves prompt diagnosis, keeping the presenting part elevated, and expedited delivery by caesarean section if vaginal delivery is not imminent. For live fetuses, minimizing cord compression and reducing the decision to delivery time are critical.
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
Management of cases with Vaginal Breech Delivery.
Dr Manavita Mahajan is a renowned Gynaecologist and is a Sr. Consultant at FRMI, Gurgaon. You can contact her at www.drmanavitamahajan.in
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Uterine rupture - All you need to know.Sandeep Das
This presentation gives the detailed information about uterine rupture - definition, epidemiology, classification, signs and symptoms, prevention and management.
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
Management of cases with Vaginal Breech Delivery.
Dr Manavita Mahajan is a renowned Gynaecologist and is a Sr. Consultant at FRMI, Gurgaon. You can contact her at www.drmanavitamahajan.in
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Uterine rupture - All you need to know.Sandeep Das
This presentation gives the detailed information about uterine rupture - definition, epidemiology, classification, signs and symptoms, prevention and management.
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
This presentation was prepared by me, Dr. P. Chizororo, to help fellow professionals understand one of the most common malpresentations, Breech presentation. Visit my YouTube channel, Nexus Medical Media for all pre-clinical subjects
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. Definition
Cord prolapse
descent of the umbilical cord through the
cervix alongside (occult) or past the
presenting part (overt) in the presence of
ruptured membranes.
3. Definition
Cord presentation
is the presence of one or more loops of
umbilical cord between the fetal presenting
part and the cervix, with intact membranes
6. Incidence
0.2% of all births
Fetal perinatal mortality is as high as 25-50% from
asphyxia (due to mechanical cord compression and
spasm of the cord), and complications of prematurity,
low birth weight etc..
7. Background
With breech presentation, the incidence is just above 1%.
Male fetuses seem to be predisposed.
The incidence is higher in multiple gestations.
8. Cases of cord prolapse appear consistently in
perinatal mortality enquiries, and one large study
found a perinatal mortality rate of 91 per 1000.
9. Prematurity and congenital malformation account for
the majority of adverse outcomes associated with cord
prolapse in hospital settings, but cord prolapse is also
associated with birth asphyxia and perinatal death with
normally-formed term babies, particularly with home birth.
Delay in transfer to hospital appears to be an important
factor with home birth.
10. Asphyxia may also result in hypoxic-ischaemic
encephalopathy and cerebral palsy.
The principal causes of asphyxia in this context are
thought to be :
cord compression preventing venous return to the
fetus and
umbilical arterial vasospasm secondary to exposure to
vaginal fluids and/or air.
11. Because of the emergent nature and rare incidence of the
condition, there are no randomised controlled trials
comparing interventions.
There are a large number of case reports, case-control studies
and case series.
12. Risk factors
Several risk factors are associated with cord prolapse .
In general, they predispose to cord prolapse by preventing
close application of the presenting part to the lower part of
the uterus and/or pelvic brim.
Rupture of membranes in such circumstances compounds
the risk of prolapse.
13. Cord abnormalities (such as true knots or low content
of Wharton’s jelly) and Fetal hypoxia-acidosis may alter
the turgidity of the cord and predispose to prolapse.
16. Ultrasound examination is not sufficiently sensitive or
specific for identification of cord presentation
antenatally and should not be performed routinely to
predict cord prolapse.
17.
18. PREVENTION
Women with transverse, oblique or unstable lie should
be offered elective admission to hospital at 37+6 weeks of
gestation, or sooner if there are signs of labour or
suspicion of ruptured membranes.
Women with noncephalic presentations and preterm
prelabour rupture of the membranes should be offered
admission.
19. In-patient care will minimise delay in diagnosis and
management of cord prolapse.
Labour or ruptured membranes of an abnormal lie is
an indication for caesarean section.
20. Bradycardia or variable fetal heart rate decelerations
have been associated with cord prolapse and their presence
should prompt vaginal examination.
Mismanagement of abnormal fetal heart rate patterns is the
commonest feature of substandard care identified in
perinatal death associated with cord prolapse.
21. Speculum and/or a digital vaginal examination
should be performed when cord prolapse is
suspected, regardless of gestation.
Prompt vaginal examination is the most important
aspect of diagnosis.
It is important to avoid digital vaginal examinations in
women with preterm labour, but suspicion of cord
prolapse was regarded as an exception to that rule.
22. Artificial rupture of membranes should be avoided
whenever possible if the presenting part is unengaged
and mobile.
If it becomes necessary to rupture the membranes in
such circumstances, this should be performed in
theatre with capability for immediate caesarean birth.
23. Vaginal examination and obstetric interventions in
the context of ruptured membranes carry a risk of
upwards displacement of the presenting part and
cord prolapse.
Pressure on the presenting part should be kept to a
minimum in such women.
Rupture of membranes should be avoided if on
vaginal examination the cord is felt below the
presenting part in labour (Cord presentation)
A caesarean section should be performed.
24. Diagnosis
When SROM occurs, it is essential to auscultate the fetal
heart, perform a speculum examination and/or vaginal
examination.
The possibility of cord prolapse should always be
considered whenever there is a high head,
malpresentation, polyhydramnios or multiple pregnancy.
Following SROM, cord prolapse might be indicated by
decelerations on the CTG trace.
25. Cord presentation and prolapse may occur without
outward physical signs.
The cord should be felt for at every vaginal examination
and after spontaneous rupture of membranes in labour.
26. Cord prolapse should be suspected when there is an
abnormal fetal heart rate pattern (bradycardia, variable
decelerations etc) in the presence of ruptured
membranes, particularly if such changes occur soon
after membrane rupture, spontaneously or with
amniotomy.
27. Speculum and/or digital vaginal examination
should be performed at preterm gestations when
cord prolapse is suspected.
30. First Stage Management
Keep your hand in the vagina, continuously
pushing the presenting part up to avoid cord
compression.
Call for help: senior obstetrician, midwives,
anaesthetist, paediatrician crash bleep for
emergency CS (theatre staff)
Note whether the cord is still pulsating, replace
it into vagina if necessary to keep it warm, do
not handle cord any further as this can cause
spasm.
31. Give facial oxygen to the women to aid
perfusion to the fetus.
Stop syntocinon …. If in progress
Monitor fetal heart continuously via CTG
32. Place the patient in KNEE CHEST position (tilt the bed
head down) or TRENDELENBURG position (all four
position)
Dislodge / Elevate the presenting part above the pelvic
inlet, to keep pressure off the cord and continue doing so
until LSCS is in progress and you are to remove your hand
by the surgeon
A Foley's catheter can also be used with 500 ml of saline,
to fill the bladder to push the head up and to keep the
cord back in place until an emergency LSCS can be
performed. This might give time for regional anaesthesia
if CTG is normal.
33. Transfer to theatre urgently
If the bladder was fill with saline, remember to
empty it before entering peritoneal cavity.
34. Cord prolapse at full dilatation
Consider ventouse / forceps delivery if you are
anticipating immanent vaginal delivery but consider
safety above all.
35. Non-viable fetus
Confirm intra-uterine death with USS
Await spontaneous delivery
If the fetal heart was definitely recorded in the
preceding 5 mins, an Emergency LSCS may still be
appropriate.
36. There are insufficient data for the evaluation of
manual replacement of the prolapsed cord above
the presenting part to allow continuation of labour.
This practice is not recommended
To prevent vasospasm, there should be minimal
handling of loops of cord lying outside the vagina
which can be covered in surgical packs soaked in
warm saline.
37. To prevent cord compression, it is recommended
that the presenting part be elevated either
manually or by filling the urinary bladder.
Cord compression can be further reduced by the
mother adopting the knee–chest position or head-
down tilt (preferably in left-lateral position).
38. Elevation of the presenting part is thought to relieve pressure
on the umbilical cord and prevent mechanical vascular occlusion.
Manual elevation is performed by inserting a gloved hand or two
fingers in the vagina and pushing the presenting part upwards.
Excessive displacement may encourage more cord to prolapse.
Remove the hand from the vagina once the presenting part is
above the pelvic brim, and apply continuous suprapubic pressure.
39. If the decision-to-delivery interval is likely to be prolonged,
particularly if it involves ambulance transfer, elevation
through bladder filling may be more practical.
Bladder filling can be achieved quickly by inserting the cut
end of an intravenous giving set into a Foley’s catheter.
The catheter should be clamped once 500-750 ml have been
instilled.
It is essential to empty the bladder again just before any
delivery attempt, be it vaginal or caesarean section.
40. Tocolysis can be considered while preparing for
caesarean section if there are persistent fetal heart
rate abnormalities after attempts to prevent
compression mechanically and when the delivery is
likely to be delayed.
Although the measures described above are
potentially useful during preparation for delivery,
they must not result in unnecessary delay.
41. A caesarean section is the recommended mode of delivery in
cases of cord prolapse when vaginal delivery is not imminent,
in order to prevent hypoxia-acidosis.
optimal mode of delivery with cord
prolapse
42. Recommendation:
Reassess cervical dilatation (particularly in the
multigravida in strong labour) prior to commencing an
emergency caesarean section as the woman may well
have achieved full dilatation and may now be suitable
for an assisted vaginal delivery.
43. Caesarean section is associated with a lower perinatal
mortality and reduced risk of APGAR score <3 at 5 minutes
compared to spontaneous vaginal delivery in cases of cord
prolapse when delivery is not imminent.
However, when vaginal birth is imminent, outcomes are
equivalent to and possibly better than those for caesarean.
44. A caesarean section of urgency category 1 should be
performed within 30 minutes or less if there is cord
prolapse associated with a suspicious or pathological
fetal heart rate pattern.
Verbal consent is satisfactory.
45. The 30-minute decision-to-delivery interval (DDI) is the
target for category 1 CS.
For women at term with a grossly pathological fetal
heart rate pattern on transfer from home (severe
bradycardia), category 1 caesarean section should be
advised
For women with a grossly pathological pattern at
extremely preterm gestations (24-26 weeks), a
discussion of the chance of survival should be offered
and the options of delivery and expectant management
discussed.
46. Category 2 caesarean section is appropriate for
women in whom the fetal heart rate pattern is
normal.
The presenting part should be kept elevated while
anaesthesia is induced.
Regional anaesthesia may be considered in
consultation with an experienced anaesthetist.
47. Vaginal birth, in most cases operative, can be
attempted at full dilatation if it is anticipated that
delivery would be accomplished within 20 minutes
from diagnosis.
With parous women or for second twins, ventouse
extraction can be attempted by experienced
operators at 9 cm dilatation if there are severe CTG
abnormalities and an easy delivery is anticipated.
48. Breech extraction can be performed under some
circumstances, e.g. after internal podalic version for the
second twin, or for singleton breech babies when the
presenting part is distending the perineum.
49. A practitioner competent in the resuscitation of the
newborn, usually a neonatologist, should attend all
deliveries with cord prolapse.
Neonates liveborn after cord prolapse are at significant
risk of needing neonatal resuscitation, as evidenced
by a high rate of low APGAR scores (<7); 21% at one
minute and 7% at five minutes.
50. management in community settings?
To prevent vasospasm, there should be minimal
handling of loops of cord lying outside the vagina.
51. Perinatal mortality is increased by more than ten-fold in
cases occurring outside hospital compared to inside the
hospital, and neonatal morbidity is also increased in
this circumstance.
53. Expectant management can be considered for cord
prolapse complicating pregnancies with gestational
age at the limits of viability.
Women should be offered both continuation and
termination of pregnancy following cord prolapse
before 24 completed weeks of pregnancy.
54. At extreme preterm gestational age (before 28
weeks), expectant management has been recorded for
periods up to three weeks.
Prolongation of pregnancy at such gestational ages
creates a chance of survival but morbidity from
prematurity remains a frequent serious problem.
Some women might prefer to choose termination of
pregnancy, perhaps after a short period of observation to
see if labour commences spontaneously.
56. After severe obstetric emergencies, women might be
psychologically affected with postnatal depression, post-
traumatic stress disorder, or fear of further childbirth.
Women with cord prolapse who undergo urgent
transfers to hospital are possibly particularly vulnerable
to psychological trauma.
Debriefing is an important part of maternity care and
should be offered by a suitably trained professional.