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Cord Prolapse.pdf

  1. OBSTETRICS Prolapsed umbilical cord By BAHAIA ALI MD OBG
  2. Prolapsed umbilical cord ▪ Prolapsed umbilical cord is a portion of the umbilical cord that falls in front of, lies beside, or hangs below the fetal presenting part. Umbilical cord prolapse is an obstetric emergency that requires immediate intervention to prevent fetal hypoxia. Delayed management is associated with significantly increased morbidity and mortality
  3. TYPES OF PROLAPSED UMBILICAL CORDS ❖can be occult or overt 1. An occult prolapse is hidden. It can't be seen or felt during a vaginal examination
  4. An overt prolapse can be seen protruding from the vagina and precedes the fetus' head or presented part
  5. Assessment findings sudden appearance of a loop of umbilical cord at the introitus after rupture of the amniotic membranes fetal heart rate decelerations after rupture of the amniotic membranes that don't resolve with position changes fetal bradycardia with rupture of the amniotic membranes a visible or palpable umbilical cord on vaginal examination
  6. Risk factors Prematurity Multiple pregnancy Polyhydramnios Malpresentations Obstetric manipulation
  7. WHEN YOU SUSPECTED CORD PROLAPSE AS HEALTH CARE PROVIDER? when you note an abnormal fetal heart rate (FHR) pattern, particularly if it occurs soon after membrane rupture, spontaneously, or with amniotomy
  8. Management •Cord prolapse is an obstetric emergency ➢ prepare for immediate delivery ➢ Explain emergency measures and their rationales to the patient and support person to increase their understanding and enhance cooperation ➢ Obtain consent for delivery, as indicated ➢ Help the patient into a knee-chest, Trendelenburg, or left-lateral Sims position and then elevate the buttocks using pillows to reduce pressure from the presenting part on the cord prolapse ➢ Administer oxygen to the patient via a mask, to improve fetal oxygenation ➢ perform hand hygiene and put on sterile gloves and place a gloved hand in the patient's vagina to elevate the presenting part and to separate the cord from the presenting part and bony pelvis ➢ Don't remove your hand until the neonate can be delivered by emergency cesarean birth if cervical dilation is incomplete. ➢ If the cervix is fully dilated, may deliver the neonate quickly using forceps.