cord prolpase for undergraduate
DESCRIPTION
Undergraduate course lectures in Obstetrics &Gynecology ,Faculty of Medicine,Zagazig University ,Prepared by DR Manal BeheryTRANSCRIPT
Definition
Cord Presentation: Cord in front of presenting part before the rupture of membranes
Cord Prolapse: Cord in front of presenting part after rupture of
membranes
Cord presentation vs. Cord prolapse
Occult cord prolapse
• Cord lying alongside the presenting part• Occult vs. presentation vs. prolapsed cord
IncidencePrimigravida 0.45%Multigravida 0.66% (Risk ratio 2:3)Cephalic 0.3%Frank breech 0.9%Complete breech 5%Footling 10%Shoulder 15%Contracted pelvis 4-6 times
CausesMalpresentation - face, brow, breech and shoulderPrematurityPolyhydramniosMultiple pregnancyLong cord (90-100 cm)PROMCPDObstetric interventions - Amniotomy, Intrauterine
pressure catheter, scalp electrode, external cephalic version,
Dangers• Mortality rate as high as 50%• Hypoxia• Spasm of vessels• Operative trauma to suboxgenated
fetus
DiagnosisCord pulsations
CTG shows variable decelerations Fundal pressure causes bradycardiaMeconium stained liquor
US – cord loops Cord outside vulva
Prevention1. Do US for malpresentation and cord
presentation
2.FHR monitoring
3.Avoid ARM in an unengaged head
4.PV exam after ROM
ManagementLift presenting part off the cord Instruct patient NOT to push Position 1. Knee chest
2. Trendelenburg
3.Exaggerated position
Knee chest position
Trendelenburg position
Exaggerated sim’s position
Management (cont..)• Vulval pad• Replacement of cord• Tocolysis (ritodrine)Funic ReductionManual replacement of cord into uterusCord gently pushed above presenting
part while other cord decompression techniques are applied
Stage II Labor:
- Expedite delivery with episiotomy and vacuum extraction or forceps
Prepare for resuscitation of the newborn.
Fetal Mortality• Overall - 50%• 1st stage of labour - 70%• 2nd stage of labour -30%• Neonatal death - 4%• Perinatal mortality- 20%
Fetal Mortality
Fetal Mortality• More with vertex than breech
• More with anterior than posterior.
• More in prime than multi
• < 5 minutes, prognosis good, > 5 mins, damage and death.
•
Prognosis
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