Flashcards in Cord prolapse Deck (12)
Define cord prolapse
A loop of umbilical cord is below the presenting part when membranes are ruptured
What is the incidence of cord prolapse?
Does it affect more multips or primips?
What is the mortality rate and why?
25-50% - asphyxia
What causes asphyxia?
-mechanical compression of cord between presenting part and bony pelvis
-spasm of cord vessels when exposed to cold or manipulated
How do you diagnose cord prolapse?
VE - often preceded by fetal heart changes
What do you do before managing cord prolapse?
ensure there is fetal heart via USS
What are the antenatal risk factors for cord prolapse? 7
oblique or transverse lie
Expectant management of prom
previous cord prolapse
what are the Intrapartum risk factors for cord prolapse? 7
internal podalic version (grap foot and pull) (second twin)
disimpaction of fetal head during rotational assisted delivery
fetal scalp electrode application
How do you manage cord prolapse? 5
-Recognise, elevate, alleviate, deliver (READ)
- Aim - to reduce compression of the cord with minimal manipulation
-Traditionally delivery via lscs but if funic reduction successful consider ventouse
-consider +IV fluids, 02 via facial mask, discontinuing oxytocin
-if cord protruding out of introitus may need sterile gauze soaked in warm saline to moisten or replace into vagina
How do you reduce the cord compression?
manual elevation of presenting part
bladder filling - saline in via catheter
knee-chest position, exagerated simms, trendelenburg