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Cord prolapse
- 1. PROLAPSE OF CORD MS.NEHA BARARI ASSISTENT PROFESSOR SNSR SHARDA UNIVERSITY
- 2. WHAT IS UMBILICALCORD Connects the fetus to the placenta. It contains two umbilical arteries and one umbilical vein, surrounded by Wharton’s jelly.
- 3. CONTD…. It supplies thefetus with oxygenated, nutrient rich blood from placenta. it measures about 50cm long and about 2cm diameter.
- 4. UMBILICAL CORD PROLAPSE •It israre emergency that occurs when umbilical cord descends alongside or beyond the fetal presenting part.
- 5. DEFINITION It is definedas 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 cordis compressed or squeezed, the baby’s supply of blood and oxygen is cut off. Severe damage or death
- 8. INCIDENCE • It rangesbetween 0.14% to 0.62% of all births. • Mortality rate for the fetus is 11-17%.
- 9. CONTD…. • Incidence ofcord 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.Cordpresentation. 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 slipsdown below the presenting part. It is felt lying in the intact bag of membranes.
- 14. CORD PROLAPSE Cord islying inside the vagina or outside the vulva following the rupture of the membranes.
- 16.
- 17. 1.Premature rupture of membranescontaining amniotic fluid. 2.Premature birth 3.Multiple births
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- 23. CONTD… 10. Iatrogenic 11. Cephalopelvicdisproportion
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- 25. RISK FACTORS Can bedivided 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 Lowlaying placenta High fetal station
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- 29. CONTD… Multiple gestation Malpresentation Premature ruptureof amniotic sac. Polyhydramnios
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- 31. SYMPTOMS Seeing or feelingthe 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- Prolapsedcord and pelvic examination. 3.Fetal heart monitor Bradycardia.
- 33. CONSEQUENCES CORD PROLAPSE FETUS CANPUT STRESS ON THE CORD LOSS OF OXYGEN TO FETUS STILL BIRTH
- 34. MANAGEMENT It is guidedby three things 1.Baby is living or dead. 2.Maturity of the baby. 3.Degree of dilatation.
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- 36. Baby dead 1.Confirm with ultrasound 2.Wait for spontaneous delivery or destructive operation
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- 39. First aid A. Bladderfilling B. Posture
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- 41. COMPLICATIONS MATERNAL 1. Haemorrhage andoperative complications. 2. Vaginal deliveries- Lacerations of cervix, vagina or perineum.
- 42. NEONATAL 1.Hypoxia 2.Acidotic 3.Near death Paediatric teamshould be present.
- 43. PREVENTION Patients at riskfor umbilical prolapse should be assessed. Careful fetal heart monitoring during the initial stages of labor is crucial.
- 44. CONTD…. Patients with malpresentation shouldbe considered for ultrasonographic examination at the onset of labor to determine fetal lie and cord position within uterine cavity.
- 45. CONTD…. Artificial rupture of membranesshould be avoided until the presenting part is well applied to the cervix.
- 46. CONTD…. • At thetime of spontaneous membrane rupture, a prompt, careful pelvic examination should be performed to rule out cord prolapse.
- 47.
- 48. CONTD…. Nursing management startswith 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 prolapsecord 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 theclient 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 headof 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. Gentlywrap gauze soaked in sterile normal saline solution around the prolapsed cord.
- 55. CONTD…. Provide physicaland emotional support. Provide client and family education.
- 56. CONTD…. Bladder filling- Doneto 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.
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- 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.
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