Cord prolapse.pptx

CORD CLAMP

1. CORD PROLAPSE Pre pare d by- JOISY S JOY Lecturer Mai Khadija Institute of Nursing Sciences , Jodhpur.

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3. DEFINITION The cord is lying inside the vagina or outside the vulva in front of the presenting part following rupture of the membrane. 3

4. Incidence The incidence of cord prolapse is about 1 in 300 deliveries. It occurs mostly in parous women especially in higher parities. 4

5. Etiology /risk factors- Mal presentation- transverse or breech Contracted pelvis Prematurity Twins Hydramnios Placental factor-minor degree of placenta previa with marginal insertion of cord for long cord Iatrogenic-low rupture of membrane, manual rotation of head Stabilizing induction 5

6. Classification There are three types of umbilical prolapse that can occur: Overt umbilical cord prolapse : Descent of the umbilical cord past the presenting fetal part. In this case, the cord is through the cervix and into or beyond the vagina. Overt umbilical cord prolapse requires rupture of membranes. This is the most common type of cord prolapse. Occult umbilical prolapse : Descent of the umbilical cord alongside the presenting fetal part, but has not advanced past the presenting fetal part. Occult umbilical prolapse can occur with both intact or ruptured membranes. 6

7. Funic (cord) presentation : Presence of the umbilical cord between the presenting fetal part and fetal membranes. In this case, the cord has not passed the opening of the cervix. In funic presentation, the membranes are not yet ruptured. 7

8. Diagnosis Cord is palpated directly by the fingers and its pulsation can be felt if fetus is alive. It may cease during uterine contraction and return after the contraction passes off. An abnormal heart rate particularly bradycardia following rupture of membranes. A loop of cord may be visible at the vulva. the cord is more commonly felt in the vagina or in cases where the presenting part is very high it may be felt in cervical os. Ultrasonography 8

9. Immediate care Call for immediate assistance. Explain to mother and family the findings and measures that will be needed. If an oxytocin infusion is in progress it should be stopped. Check if the cord is pulsating, if so it should be handled as little as possible as spasm may occur through handling. If cord is outside the vagina, it should be replaced gently to maintain temperature. Relieve pressure on the cord during contractions by keeping a finger of the midwife in the vagina and holding the presenting part of the umbilical cord. 9

10. Position the mother with the pelvis and buttocks elevated. Place the women in knee-chest position which causes the fetus to gravitate towards the diaphragm relieving the compression on the cord. Keep the foot of the bed raised until the delivery of the baby either vaginally or by cesarean section. 10

11. Assisted vaginal delivery - If the cervix is fully dilated, or almost fully dilated in a multi para assisted vaginal delivery by forceps or vacuum extraction is indicated where the presentation is vertex. Management Replacement of the umbilical cord and positioning - If the mother is not in a hospital or the cervix is only partially dilated, replacement of the cord and elevation of the hips in lateral position must be carried out until she is transferred to a hospital. 11

12. Cesarean section Immediate cesarean section is the management of choice in instances where the fetus is alive and delivery is not imminent or vaginal birth cannot be initiated. Risks to the fetus The risk to the fetus are hypoxia and death as a result of cord compression. The average fetal mortality is 50%. The risks are greater with prematurity and low birth weight. The risk is less in multi para than in primary gravida because of shorter labor in the former. 12

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