WEEK 5B - Cord Prolapse / Emergency Caesarean Flashcards
(17 cards)
What is cord prolapse?
When the umbilical cord descends past the foetal presenting part and beyond the internal cervical os, in the presence of ruptured membranes.
Cord prolapse can be classified as overt or occult.
Define overt cord prolapse.
If the cord is below the presenting part and in the vagina or outside vulval introitus.
Overt cord prolapse is a more visible and urgent situation.
Define occult cord prolapse.
If the cord is lying alongside the presenting part.
Occult cord prolapse may not be immediately apparent.
What is cord presentation?
When the umbilical cord is positioned between the foetal presenting part and the cervix, with or without ruptured membranes.
List potential causes of cord prolapse.
- Presenting part of the foetus not fitting into the maternal inlet
- Grand multiparity
- Maternal pelvic abnormalities
- Relatively long cord
- Low placental implantations
- Amniotomy
- Induction
- Insertion of a supracervical balloon catheter for IOL
- ECV
- High presenting part of foetus
How can cord prolapse be identified?
Prediction through transvaginal scanning in women with high risk factors such as transverse lie, malpresentation, or high presenting part of fetus.
What preventive measures can be taken for cord prolapse?
- Offer ECV at 37 weeks for women with transverse, oblique, or breech lie
- Admission to hospital at 38 weeks for women with persistent breech, transverse, or oblique lie
- Advise immediate admission for at-risk women with any signs of labor or prolonged rupture
- Check for cord presence at each VE
- Contraindicate amniotomy if cord is palpable below or by the side of the presenting part
What is the management strategy for cord prolapse?
- Prevent or minimize foetal hypoxia
- Check foetal pulse on cord and use of CTG or dopplers
- Place mother in head down or knee to chest position
- Counsel mother on the situation
- If delivery is not imminent in 15 mins, perform caesarean
- Push foetal presenting part off the cervix without compressing cord
What are the common clinical situations that lead to emergency caesarean section?
- Abnormal CTG / foetal distress
- Elective caesarean
- Obstruction of labour
- Failure to progress
What are the categories of caesarean section based on clinical presentations?
- Category One: Urgent threat to life or health
- Category Two: Maternal or foetal compromise but not life threatening
- Category Three: Needing earlier delivery without evident compromise
- Category Four: At a time acceptable to both the woman and the team
What defines Category One caesarean section?
Urgent threat to the life or health of a woman or foetus.
What are examples of situations classified under Category One caesarean section?
- Cord prolapse
- Failed instrumental birth with foetal compromise
- Maternal cardiac arrest
- Abnormal foetal scalp blood sample
- Confirmed foetal blood indicating ruptured foetal blood vessel
- Sustained foetal bradycardia
- Placental abruption
- Major haemorrhage with placenta praevia
What does Category Two caesarean section involve?
Maternal or foetal compromise but not immediately life threatening.
What situations are included in Category Three caesarean section?
- Failure to progress
- Malpresentations in early labour
- Planned caesarean section presenting in labour
- Maternal condition requiring stabilisation
What role does the midwife play in preparing a woman for emergency caesarean section?
- Provide psychological support
- Educate on C/S necessity
- Prepare partner
- Prepare for theatre with checklist
- Look after baby after delivery
- Support mother and baby in recovery
What are potential psychosocial outcomes for women after an emergency caesarean section?
- May feel like a failure
- May be traumatised
- May feel uninformed due to fast-paced nature of the procedure
