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Flashcards in Cord prolapse Deck (12)
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1

Define cord prolapse

A loop of umbilical cord is below the presenting part when membranes are ruptured

2

What is the incidence of cord prolapse?

0.2%

3

Does it affect more multips or primips?

multips

4

What is the mortality rate and why?

25-50% - asphyxia

5

What causes asphyxia?

-mechanical compression of cord between presenting part and bony pelvis
-spasm of cord vessels when exposed to cold or manipulated

6

How do you diagnose cord prolapse?

VE - often preceded by fetal heart changes

7

What do you do before managing cord prolapse?

ensure there is fetal heart via USS

8

What are the antenatal risk factors for cord prolapse? 7

breech
unstable lie
oblique or transverse lie
polyhydramnios
ECV
Expectant management of prom
previous cord prolapse

9

what are the Intrapartum risk factors for cord prolapse? 7

Amniotomy
prematurity
breech
internal podalic version (grap foot and pull) (second twin)
second twin
disimpaction of fetal head during rotational assisted delivery
fetal scalp electrode application

10

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

11

How do you reduce the cord compression?

manual elevation of presenting part
tocolysis
bladder filling - saline in via catheter
knee-chest position, exagerated simms, trendelenburg
funic reduction

12

What is funic reduction?

manual replacement of cord into uterus- gently pushed above presenting part
-rapid vaginal delivery