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Cord prolapse
- 1. PROLAPSE OF CORD MS. NEHA BARARI ASSISTENT PROFESSOR SNSR SHARDA UNIVERSITY
- 2. WHAT IS UMBILICAL CORD Connects the fetus to the placenta. It contains two umbilical arteries and one umbilical vein, surrounded by Wharton’s jelly.
- 3. CONTD…. It supplies the fetus with oxygenated, nutrient rich blood from placenta. it measures about 50cm long and about 2cm diameter.
- 4. UMBILICAL CORD PROLAPSE •It is rare emergency that occurs when umbilical cord descends alongside or beyond the fetal presenting part.
- 5. DEFINITION It is defined as the descent of the umbilical cord into the lower uterine segment, where it may lie adjacent to the presenting part or below the presenting part.
- 6. EFFECTS When the cord is compressed or squeezed, the baby’s supply of blood and oxygen is cut off. Severe damage or death
- 8. INCIDENCE • It ranges between 0.14% to 0.62% of all births. • Mortality rate for the fetus is 11-17%.
- 9. CONTD…. • Incidence of cord prolapse is about 1 in 300 deliveries. Mostly in parous women. • Incidence is reduced with the increased use of elective caesarean section in noncephalic presentation.
- 10. causes • Abnormal presentation • Prematurity • Obstetric manipulation • Multiparity • Multiple gestation • Placenta problems
- 11. TYPES 1.Occult cord prolapse. 2.Cord presentation. 3.Cord prolapse.
- 12. Occult Cord Prolapse The cord is placed by the side of presenting part and is not felt by the fingers on internal examination.
- 13. CORD PRESENTATION Cord slips down below the presenting part. It is felt lying in the intact bag of membranes.
- 14. CORD PROLAPSE Cord is lying inside the vagina or outside the vulva following the rupture of the membranes.
- 17. 1.Premature rupture of membranes containing amniotic fluid. 2.Premature birth 3.Multiple births
- 19. POLYHYDRAMINOS
- 20. MALPRESENTATION
- 23. CONTD… 10. Iatrogenic 11. Cephalopelvic disproportion
- 24. Abnormally long umbilical cord
- 25. RISK FACTORS Can be divided into two:- 1.Fetomaternal (baby-mother) Factors that lead to an inadequate filling of the pelvis by baby’s presenting part. 2.Obstetric interventions.
- 26. CONTD…. Pelvic tumors Low laying placenta High fetal station
- 28. MACROSOMIA
- 29. CONTD… Multiple gestation Malpresentation Premature rupture of amniotic sac. Polyhydramnios
- 31. SYMPTOMS Seeing or feeling the umbilical cord in the vagina On examining with fetal monitor, fetal with prolapsed cord usually has decreased heart rate (less than 120 beats per minutes).
- 32. DIAGNOSIS 1.History taking. 2.Physical examination- Prolapsed cord and pelvic examination. 3.Fetal heart monitor Bradycardia.
- 33. CONSEQUENCES CORD PROLAPSE FETUS CAN PUT STRESS ON THE CORD LOSS OF OXYGEN TO FETUS STILL BIRTH
- 34. MANAGEMENT It is guided by three things 1.Baby is living or dead. 2.Maturity of the baby. 3.Degree of dilatation.
- 36. Baby dead 1.Confirm with ultrasound 2. Wait for spontaneous delivery or destructive operation
- 39. First aid A. Bladder filling B. Posture
- 41. COMPLICATIONS MATERNAL 1. Haemorrhage and operative complications. 2. Vaginal deliveries- Lacerations of cervix, vagina or perineum.
- 42. NEONATAL 1.Hypoxia 2.Acidotic 3.Near death Paediatric team should be present.
- 43. PREVENTION Patients at risk for umbilical prolapse should be assessed. Careful fetal heart monitoring during the initial stages of labor is crucial.
- 44. CONTD…. Patients with malpresentation should be considered for ultrasonographic examination at the onset of labor to determine fetal lie and cord position within uterine cavity.
- 45. CONTD…. Artificial rupture of membranes should be avoided until the presenting part is well applied to the cervix.
- 46. CONTD…. • At the time of spontaneous membrane rupture, a prompt, careful pelvic examination should be performed to rule out cord prolapse.
- 48. CONTD…. Nursing management starts with assessment phase, when the pregnant women visits the hospital for antenatal check ups. Nurse assess for all the risk factors in a pregnant women, so that proper treatment can be given at right time.
- 49. CONTD…. Identify prolapse cord and provide immediate intervention. 1. Assess a laboring client often if the fetus is preterm or small for gestational age, if the fetal presenting part is not engaged, and if the membranes are ruptured.
- 50. CONTD…. 2.Periodically evaluate FHR, especially right after rupture of membranes (spontaneous or surgical), and again in 5 to 10 minutes. 3. If prolapse cord is identified, notify the physician and prepare for emergency caesarean birth.
- 51. CONTD…. 4. If the client is fully dilated, the most emergent delivery route may be vaginal. In this case, encourage the client to push and assist with the delivery as follows.
- 52. CONTD…. Lower the head of the bed and elevate the client’s hips on a pillow, or place the client in the knee-chest position to minimize pressure from the cord.
- 54. CONTD…. Assess cord pulsations constantly. Gently wrap gauze soaked in sterile normal saline solution around the prolapsed cord.
- 55. CONTD…. Provide physical and emotional support. Provide client and family education.
- 56. CONTD…. Bladder filling- Done to raise the presenting part off the compressed cord till the patient delivers. Bladder is filled with 400-750 ml of saline with a Foley’s catheter, balloon is inflated and catheter is clamped.
- 57. THANK YOU
- 58. REFERENCES • http://www.rnpedia.com/home/notes/maternal- child-nursing-notes/cord-prolapse • http://www.perinatalservicesbc.ca/NR/rdonlyres /7682B7D8-166D-4990-86E4- AC68B9F16066/0/CoreCompDSTOBEmergCordPr olapse8A.pdf. • Dutta D.C. text book of obstetrics. New central book agency(P) ltd. 6th edition.