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Practice 3 > Cord prolapse/presentation > Flashcards

Cord prolapse/presentation Flashcards

1
Q

What is a cord prolapse?

A

The descent of the umbilical cord through the cervix, alongside or past the presenting part, when membranes are ruptured.

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1
Q

What is the word for alongside presenting part?

A

Occult

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2
Q

What is the word for past the presenting part?

A

Overt

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3
Q

What is a cord presentation?

A

The presence of umbilical cord between the fetal presenting part and the maternal cervix, with or without intact membranes.

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4
Q

What is the incidence of cord prolapse?

A

Range from 1.4 to 6.2 per 1000

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5
Q

What is the perinatal mortality rate?

A

91 per 1000

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6
Q

Overt cord prolapse occurs in what percentage of breech deliveries?

A

> 1%

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7
Q

What percentage does it occur in footling breech?

A

15%

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8
Q

What percentage does it occur in complete breech?

A

5%

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9
Q

What percentage does it occur in transverse lie?

A

20%

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10
Q

What are the antenatal risk factors for cord prolapse?

A

Non-cephalic lie, multiparty, polyhydramnios, unengaged PP, twins, low birth weight, prematurity

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11
Q

What are the procedural risk factors for cord prolapse?

A

ARM (high PP), ECV, Internal Podalic Version, stabilising IOL, Large balloon catheter IOL

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12
Q

What happens during a cord prolapse?

A

Fetal blood supply is obstructed

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13
Q

Why does the fetal blood supply get obstructed?

A

Drop in temperature and spasms of vessels, compression between bony pelvis and presenting part

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14
Q

What determines the level of injury for cord prolapse?

A

Amount of time from prolapse to birth

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15
Q

What can birth asphyxia cause?

A

HIE, cerebral palsy and death

16
Q

What is the prognosis outside of the hospital?

A

perinatal death is 10 times more likely

17
Q

What are some ways to prevent cord prolapse?

A

Offering ECV, PPROM inpatient care, avoid ARM if PP high

18
Q

How do we diagnose cord prolapse?

A

Cord is visible outside the introitus or during a speculum, Cord is palpable during a VE, Abnormal fetal heart rate pattern

19
Q

General Management of cord prolapse

A

Maternal position- Exaggerated Sims/ knee chest
Digital elevation presenting part
Bladder filling if expected delay

20
Q

How much terbutaline should be given?

A

0.25mg SC

21
Q

How do you do bladder filling?

A

Insert Foley catheter
Inflate balloon, and drain urine
Fill with 500mls normal saline
Switch-off flip flow valve

22
Q
A

Practice 3 (15 decks)

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