Cord prolapse Flashcards Preview

Obstetrics and Gynaecology > Cord prolapse > Flashcards

Flashcards in Cord prolapse Deck (5)
1

When to suspect cord prolapse

1. May not have any overt signs or fetal distress
2. If ROM->examine, abnormal CTG
3. Examine for cord prolapse at every presentation, after SROM, risk factors, CTG abnormal

2

Risk factors

1. General
Fetal anomalies
Second twin
Multiparity
Low BW
Prematurity
Breech.transverse/oblique/unstable lie
Low lying placenta
Unengaged presenting part
2. Procedure related
Internal podalic version
External cephalic version
ARM
Vaginal manipulation of fetus w/ ruptured membrane

3

Is USS useful

Not specific/sensitive enough to exclude

4

Prevention

1. Transverse/oblique/unstable
Elective admission after 37 + 6
Advise to present quickly if signs of labour or suspicion for ROM
2. If presenting part mobile, station high->Avoid ARM

5

Management

1. Recognise non reassuring trace
2. Assistance called
3. Prep for immediate delivery->alert obs/gynae, anaesthetics, NICU
4. Visualise/palpate the cord
5. Minimal cord handling
6. Assess fetal status->CTG, USS
7. Assess labour progress
8. Do not attempt replacement
9. IV access, IVF, bloods->FBC, UEC, GH Xmatch, catheter, analgesia
10. Elevate presenting part
Fill bladder
Knee to chest
Trendelenberg
11. Tocolysis considered if waiting c section and ongoing fetal HR abnormalities/decompression failed/delayed delivery
12. If full dilitation and anticipate quick and safe delivery->vagina
13. Otherwise cesaerean
14. Anticipate resuscitation
15. Take cord blood: pH, base excess