CORD PROLAPSE CORD PRESENTATION (1).pptx

cord proposal

1. OBSTETRIC EMERGENCIES

2. CORD PROLAPSE , CORD PRESENTATION

3. When the umbilical cord lies alongside or in front of the presenting par t while the fetal membranes are intact is known as cord presentation If the fetal membranes rupture and the cord is felt it is called cord prolapse

4. TYPES Occult cord prolapse • Cord is adjacent to the presenting part • Cannot be palpated during pelvic examination. • Might lead to variable decelerations or unexplained fetal distress. . 

5. TYPES Funic (cord) presentation • Prolapse of the umbilical cord below the level of the presenting part before the rupture of fetal membranes • Cord can often be easily palpated through the membranes

6. TYPES Overt cord prolapse • Umbilical cord lies below the presenting part • Associated with rupture of membranes, and displacement of the cord through the vagina

7. Predisposing factors Malposition Malpresenation Cephalopelvic disproportion Polyhydramnious Prematurity

8. MATERNAL and PLACENTAL factors MATERNAL Rupture of membranes Spontaneous (including preterm ROM) Amniotomy (ARM) Pelvic tumors e.g cervical fibroid Pelvic contraction Preterm labour PLACENTAL • Polyhydramnios • Minor degree of placenta previa

9. Aetiology/ Risk Factors   Cord abnormalities (such as true knots or low content of Wharton’s jelly) Fetal hypoxia -acidosis may alter the turgidity of the cord and predispose to prolapse.

10. Aetiology/ Risk Factors PROCEDURE- RELATED • Amniotomy • External Cephalic Version • Internal Podalic Version • Stabilizing Induction of labor • Applying fetal scalp electrode • Amnion infusion • Placement of a cervical ripening balloon catheter 

11. Complication Fetal distress Fetal anoxia Fetal death Emergency operative intervention Cord compression Umbilical artery vasospasm Hypoxic-Ischemic Perinatal death Encephalopathy

12. DIAGNOSIS Cord presentation and prolapse may occur without outward physical signs. Suspected during clinical examinations abnormal fetal heart rate pattern may suggest overt or occult cord prolapse (bradycardia, marked variable decelerations etc) in the presence of ruptured membranes, particularly if such changes occur soon after membrane rupture, spontaneously or with amniotomy

13. VAGINAL EXAMINATION Sudden appearance of a loop of umbilical cord at the introitus, usually just after membrane rupture May palpate cord during a vaginal examination in the absence of intact membranes Cord presentation, sometimes felt below the presenting part when membranes are intact.

14. MANAGEMENT Cord prolapse is an obstetric emergency and delivery must be as quick as possible C/S is necessarily except if : The cervix is fully dilated and the presenting part is engaged forceps or vacuum can be performed by experienced obstetrician. ◒ Death fetus with no other indication for C/S allow vaginal delivery.

15. As soon as the diagnoses is made the cord should be handled as little as possible to avoid arterial spasm Pressure on the cord can be reduced by displacing the presenting part by hand in the vagina or by placing the patient in the knee-chest position

16. Syntocin should be stopped if it was used Investigation should be sent urgently Patient should be transferred to the operating theater for emergency C/S The pediatrician should be informed to attend the delivery

17. MANAGEMENT OF OCCULT PROLAPSE Immediate vaginal examination to rule out cord prolapse Left lateral position O2 to mother Discontinue oxytocin infusion if in place Allow labor to progress if FH returns to normal and no further insult. Continuous fetal heart rate monitoring Amnioinfusion CS if cord compression pattern continues 

18. AMNIOINFUSION

19. MANAGEMENT CORD PRESENTATION • Term: CS prior to membrane rupture. • Premature: No consensus on management • Hospitalize patient on bed rest in Sim’s position or Tredelenburg position • Serial USS to ascertain cord position, presentation and GA 20

20. MANAGEMENT OF OVERT CORD PROLAPSE Speed is of the essence and perinatal outcome is largely dictated by the diagnosis-delivery interval. The three components of management are: 1. Prevent or relieve cord compression and vasospasm 2. Fetal assessment 3. Prompt delivery of the infant 

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