cord prolapse 1.pdf
- 1. CASE PRESENTATION ON CORD PROLAPSE Presented By: Dipanwita Maity, 4th Year,B.Sc. Nursing Roll: 33, Shova Rani Nursing College.
- 3. DEFINITION Cord Prolapse is the descend of umbilical cord into the lower uterine segment where it may lie adjacent to the presenting part or below its presenting part, without intact fetal membranes. When membranes are intact ,it’s called Cord Presentation.
- 4. INCIDENCE RATE OF CORD PROLAPSE Cephalic 0.3- 0.4% Breech Flexed (Frank) 0.4-0.5% Complete 5% Footling 15% Transeverse Lie 20%
- 5. Related Anatomy and Physiology
- 6. Etiology of Cord Prolapse 1) Malpresentation - Contracted Pelvis - Prematurity - Twins - Hydramnios 2) Placentalfactors 3) Iatrogenic 4) Others - Multiparity - Congenital anomalies
- 7. TYPES OF CORD PROLAPSE 1)Occult Prolapse 2)Cord Presentation 3)Cord Prolapse The cord is not The cord is slipp The cord is placed by the -ed down below lying inside side of the the presenting the vagina Presenting part part and is felt or outside and is not felt lying in the the vulva by the fingers intact bag of following the on internal membranes. Rupture of examination.Seen membranes. on USG or during C-Section.
- 8. Types Of Cord Prolapse
- 9. • Diagnosis Of Cord Prolapse : • - History taking & Physical examination • - Abnormal fetal heart rate (< 140 beats/ minute) • - Pelvic & Vaginal examination . Sudden apperance of loop of umbilical cord at the time just usually just after membrane rupture . • - Doppler sound imaging . • - Prenatal ultrasound scans before delivery .
- 10. • CONSEQUENCES • Cord compression Umbilical artery • vasospasm • • Birth Asphyxia • Hypoxic Ischemic Perinatal death • Encephalopathy
- 11. MANAGEMENT 1) COLLABORATIVE MANAGEMENT • CORD PRESENTATION: ▪ No attempt should be made to replace the cord ,once diagnosis is made. ▪ If immediate vaginal delivery is not possible or contraindicated , caesarean section is the best method of delivery .
- 12. • CORD PROLAPSE : Management protocol is guided by – 1) Baby living or dead 2) Maturity of the baby 3) Degree of cervix dialatation
- 13. MANAGEMENT •Baby living: •1) Definitivetreatment- caesarean section •2) Immediate safe vaginal delivery is possible- - Forceps delivery – if head is engaged. - Breech extraction- in breech presentation. - Internal version followed by breech extraction : in Transverse lie
- 14. MANAGEMENT 3) Immediate safe vaginal delivery is not possible: ➢ First-aid management: • Minimize pressure on the cord till when the patient is prepared for assisted deliveryor transferred tohospital.Stop oxytocin infusion, if continuous.Administer IVfluid& O2. • Bladder filling with 400-750ml NS and the balloonis inflated and clamp the catheter. •Lift the presenting part off the cord. •Trendelenburg or knee-chest position. Sim’s position.
- 16. • MANAGEMENT • • Baby Dead : • Labour is allowed to proceed awaiting spontaneous delivery
- 18. MANAGEMENT
- 19. COMPLICATIONS - Failed induction - Uterine hyper stimulation - Prematurity - Infection - Bleeding - Uterine rupture