Cord prolapse Flashcards Preview

Obstetrics and Gynaecology > Cord prolapse > Flashcards

Flashcards in Cord prolapse Deck (5)
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1
Q

When to suspect cord prolapse

A
  1. May not have any overt signs or fetal distress
  2. If ROM->examine, abnormal CTG
  3. Examine for cord prolapse at every presentation, after SROM, risk factors, CTG abnormal
2
Q

Risk factors

A
1. General
Fetal anomalies
Second twin
Multiparity
Low BW
Prematurity
Breech.transverse/oblique/unstable lie
Low lying placenta
Unengaged presenting part
2. Procedure related
Internal podalic version
External cephalic version
ARM
Vaginal manipulation of fetus w/ ruptured membrane
3
Q

Is USS useful

A

Not specific/sensitive enough to exclude

4
Q

Prevention

A
  1. Transverse/oblique/unstable
    Elective admission after 37 + 6
    Advise to present quickly if signs of labour or suspicion for ROM
  2. If presenting part mobile, station high->Avoid ARM
5
Q

Management

A
  1. Recognise non reassuring trace
  2. Assistance called
  3. Prep for immediate delivery->alert obs/gynae, anaesthetics, NICU
  4. Visualise/palpate the cord
  5. Minimal cord handling
  6. Assess fetal status->CTG, USS
  7. Assess labour progress
  8. Do not attempt replacement
  9. IV access, IVF, bloods->FBC, UEC, GH Xmatch, catheter, analgesia
  10. Elevate presenting part
    Fill bladder
    Knee to chest
    Trendelenberg
  11. Tocolysis considered if waiting c section and ongoing fetal HR abnormalities/decompression failed/delayed delivery
  12. If full dilitation and anticipate quick and safe delivery->vagina
  13. Otherwise cesaerean
  14. Anticipate resuscitation
  15. Take cord blood: pH, base excess