What is umbilical cord prolapse and how is it treated?
Aug 21, 2018 · There are several case reports of conservative management of cord prolapse and all are in pre-viable gestation fetuses with the aim of prolongation of pregnancy. 18, 19 In these cases, the extreme prematurity and low birthweight may have resulted in less cord compression, minimizing asphyxia and improving fetal outcome. 18 Pre-viable gestation is one of the …
What is cord prolapse in nursing management?
May 20, 2021 · Umbilical cord prolapse (UCP) occurs when the umbilical cord exits the cervical opening before the fetal presenting part. It is a rare obstetric emergency that carries a high rate of potential fetal morbidity and mortality. Resultant compression of the cord by the descending fetus during delivery leads to fetal hypoxia and bradycardia, which can result in fetal death or …
Does breech birth cause prolapse of the umbilical cord?
The cord may even stick out from the vagina — a dangerous situation because the blood flow through the umbilical cord can become blocked or stopped. You may feel the cord in the birth canal if it prolapses, and may see the cord if it protrudes from your vagina. This is an emergency: Call an ambulance and get to the hospital right away.
How do you remove the umbilical cord after birth?
Mortality from umbilical cord prolapse has fallen from 375 per 1000 to between 36 and 162 per 1000 live births in the last 100 years. 11 Interestingly, despite ominous fetal heart rate tracings, abnormal fetal blood gas readings, and low Apgar scores, most of the mortality is attributable to congenital anomalies and prematurity. 10.
How is a prolapsed umbilical cord treated?
Management and Treatment Umbilical cord prolapse is an acute obstetric emergency that requires immediate delivery of the baby. The route of delivery is usually by cesarean section. The doctor will relieve cord compression by manually elevating the fetal presentation part until cesarean section is performed.Sep 9, 2020
What other actions should be taken once the umbilical cord prolapse is recognized?
Once UCP is diagnosed, the fetal presenting part should be manually elevated off the cord, the patient placed in knee-chest or steep Trendelenburg position, and preparations made for cesarean delivery, unless vaginal delivery is imminent.Sep 1, 2013
What is the first thing to do with a prolapsed cord?
How is cord prolapse treated? If you think your baby's umbilical cord is prolapsed and you're not already at the maternity ward, call 911 immediately or go to the hospital right away. While you wait, get on your hands and knees with your pelvis up and head down to take pressure off of the cord.Nov 16, 2020
Which position is recommended in cord prolapse?
Advise knee-chest, face-down position whilst awaiting the ambulance. Elevate the presenting part whilst awaiting transfer and during transfer to hospital. Use the left lateral position with pillow under hip for transfer in the ambulance.Oct 27, 2021
How do you manage cord presentations?
ManagementAvoid handling the cord to reduce vasospasm.Manually elevate the presenting part by lifting the presenting part off the cord by vaginal digital examination. ... Encourage into left lateral position with head down and pillow placed under left hip OR knee-chest position.More items...
What is the biggest risk of a prolapse cord?
The greatest risk factors are an abnormal position of the baby within the uterus and a premature or small baby. Other risk factors include a multiple pregnancy, more than one previous delivery, and too much amniotic fluid. Whether medical rupture of the amniotic sac is a risk is controversial.
What do you do for a prolapse?
You could try to:Perform Kegel exercises to strengthen pelvic muscles and support the weakened fascia.Avoid constipation by eating high-fiber foods and drinking plenty of fluids.Avoid bearing down to move your bowels.Avoid heavy lifting.Control coughing.Lose weight if you're overweight or obese.Sep 19, 2020
What is prolapse of the umbilical cord?
A prolapsed umbilical cord develops when the umbilical cord drops ("prolapses") through the open cervix into the vagina in advance of the presenting part of the baby. The fear with an umbilical cord prolapse will compress the cord-cutting off the baby's needed supply of blood and oxygen.
What is the primary risk of umbilical cord prolapse to the fetus quizlet?
explanation: peformed amniotomy is a risk factor for prolapsed umbilical cord prolapse. Carla Hernandez's fetal membranes were ruptured by her provider. Immediately following the procedure, the nurse notes persistent fetal bradycardia on the fetal monitor.
How do you prevent a prolapsed umbilical cord?
How to prevent a cord prolapseAvoid having your waters broken, especially if you're not in labor and your baby's head isn't fully engaged. ... Avoid cervical checks during pregnancy and labor, because of the risk of accidental rupture of membranes.More items...•6 days ago
What is Umbilical Cord Compression?
Sometimes the umbilical cord gets stretched and compressed during labor, leading to a brief slow down in blood flow to your baby. This can cause sudden, short drops in fetal heart rate, called variable decelerations, which are usually picked up by monitors during labor. Umbilical cord compression can occur during pregnancy or during labor.
What are the Dangers
When your baby’s heart rate changes as a result of compression, it can lead to complications like variable deceleration.
What Causes a Prolapsed Umbilical Cord?
During labor, the umbilical cord gets stretched and compressed, leading to umbilical cord compression. While you are pregnant, the hyperactivity of your baby can, on rare occasions, cause umbilical cord compression. Another cause is a preterm premature rupture of membranes (PROM).
How do I Know if the Umbilical Cord is Compressed or Prolapsed?
Umbilical cord compression can be diagnosed before labor by one of two doctors test; either a fetal Doppler or an ultrasound. Unfortunately, there are no visible signs of umbilical cord compression that can be seen without the help of a doctor.
Treatments
One of the leading treatments of umbilical cord compression is amnioinfusion. Amnioinfusion is a process that involves introducing a saline solution, at room temperature, into the uterus during labor in order to relieve the pressure that can potentially lead to the umbilical cord becoming compressed.
What is the umbilical cord?
The umbilical cord is a vital intra-amniotic structure that occasionally develops catastrophic complications. Although these events are rare, understanding of risk factors, presentation, and management options can assist in positive outcomes for fetus and mother. The human fetal umbilical cord is derived from embryonic mesodermal layers ...
What are the abnormalities of the umbilical cord?
Other abnormalities of the umbilical cord can complicate labor and delivery. The umbilical cord normally inserts near the center of the placenta. In approximately 1% of placentas, the cord insertion is on the membranes, known as velamentous insertion. 1 The umbilical vessels course over the membranes separately, without the protection of Wharton's jelly and thus are more vulnerable to trauma, including rupture of membranous vessels and vasa previa (Fig. 4). Vasa previa, occurring in 1 of 2000 24 to 5000 deliveries, is a variation of a funic presentation, although it carries possibly more serious risks, since the unprotected umbilical vessels precede the presenting part. Spontaneous rupture of the vessels can occur, or iatrogenic laceration can occur during artificial rupture of membranes or other obstetric manipulation, including cervical ripening, insertion of monitoring devices, or scalp gas sampling. If the vessels are lacerated, rapid fetal exsanguination can occur if delivery is not accomplished immediately. Mortality rate of 70–100% is expected with ruptured vasa previa. 25
What is occult cord prolapse?
In contrast, occult cord prolapse is defined as the position of the cord alongside but not past the presenting part. Frequently it is encountered intrapartum, when fetal heart rate abnormalities lead to palpation of loops of cord around or ahead of the presenting part, often with still intact membranes.
How is the umbilical cord formed?
The cord is formed by the union of the body stalk and the omphalomesenteric duct. 1 Within the cord are three fetal vessels: normally two arteries and one vein.
Why is the cord prolapsed in premature fetus?
The premature fetus has a higher incidence of cord prolapse events due to its smaller volume filling the pelvis, as well as the relative increase in the amount of fluid surrounding it. There has been concern over the role of obstetric maneuvers in promoting prolapse of the cord.
How long does it take to do an ultrasound of the umbilical cord?
24 Ultrasound evaluation of the umbilical cord throughout its length is best done between 24 and 27 weeks.
How many live births are visualized on ultrasound?
This is visualized on ultrasound in approximately 1 in 167 (0.6%) live births. 18 The increased use of antepartum obstetric ultrasound, especially with color flow Doppler, has assisted in making the diagnosis of a presenting cord and preparing for cesarean delivery before overt or occult prolapse.
How Common Is It?
Umbilical cord prolapse occurs approximately in one out of every 300 births. However, the mortality rate due to the condition has gone down considerably. This is due to the feasibility of caesarean delivery options and the advancement in neonatal care and resuscitation.
Causes
There may be several causes for the condition. Some of the reasons for the prolapsed umbilical cord are,
Symptoms
If the umbilical cord is visible during the delivery or the doctor can feel the cord during delivery.
Diagnosis
An overt umbilical cord prolapse, in which the cord is usually visible past the vagina during the time of delivery, is done through a vaginal examination.
Risk Factors
There are many risk factors that cause complications of cord prolapse during delivery. Some of them are,
Treatment and Management
Umbilical cord prolapse puts the baby at immediate risk, and these are methods followed as remedies for umbilical cord prolapse.
Prevention
To lower the risk of prolapsed umbilical cord nursing interventions that may act as risk, the following factors need to be avoided:
What should a nurse do with a prolapsed cord?
The nurse should: The client with a prolapsed cord should be treated by elevating the hips and covering the cord with a moist, sterile saline gauze. The nurse should use her fingers to push up on the presenting part until a cesarean section can be performed. Answers A, B, and D are incorrect.
Why is the umbilical cord compressed?
Umbilical cord prolapse. Because umbilical cord’s insertion site is born before the fetal head, the cord may be compressed by the after-coming head in a breech birth. When the bag of waters ruptures spontaneously, the nurse should inspect the vaginal introitus for possible cord prolapse.
Why is breech position common?
Question 10 Explanation: In a breech position, because of the space between the presenting part and the cervix, prolapse of the umbilical cord is common. Quickening is the woman’s first perception of fetal movement. Ophthalmia neonatorum usually results from maternal gonorrhea and is conjunctivitis.
What is the term for the descent of the umbilical cord into the vagina ahead of the fetal
Cord prolapse is descent of the umbilical cord into the vagina ahead of the fetal presenting part with resulting compression of the cord between the presenting part and the maternal pelvis. Cord prolapse is an emergency situation; immediate delivery will be attempted to save the fetus. It occurs in 1 of 200 pregnancies.
What is the nursing management of a fetus?
Nursing Management. 1. Identify prolapse cord and provide immediate intervention. Assess a laboring client often if the fetus is preterm or small for gestational age, if the fetal presenting part is not engaged, and if the membranes are ruptured.
How long does it take to evaluate a FHR?
Periodically evaluate FHR, especially right after rupture of membranes (spontaneous or surgical), and again in 5 to 10 minutes. If prolapse cord is identified, notify the physician and prepare for emergency cesarean birth. If the client is fully dilated, the most emergent delivery route may be vaginal.
How many beats per minute does a nurse count?
While auscultating for the point of maximum intensity of fetal heart tones before applying an external fetal monitor, the nurse counts 100 beats per minute.
What is the umbilical cord?
Umbilical cord is how fetus gets oxygenation. Pressure is applied from the fetus on the displaced cord, then oxygenation is compromised. It is the babies oxygen supply can not be delivered before the baby. This is a medical emergency.
What is the NCLEX course?
The Maternal Nursing for the NCLEX® Course breaks down the most important things you need to know to care for a client before, during, and after pregnancy. Every aspect is broken down into manageable chunks to eliminate confusion and overwhelm. We help you understand what common risks and complications are, how the baby grows and develops, and how to assess both mom and baby after the baby is born. We even talk about medications that are commonly given during pregnancy.
Can oxygen be delivered before delivery?
The babies oxygen supply can not be delivered before the baby. This is a medical emergency! So the assessment of this is going to be either a visualization of the cord protruding from vagina or you feel a pulsation or something squishy on a cervical exam.
Does oxygen help a fetus?
So if you are told that your patient’s saturation is 100% it doesn’t matter you are going to give her oxygen. The extra oxygen is going to help the fetus. The fetal heart rate will be watched for signs of hypoxia.
Can a baby be delivered after a C section?
The patient needs to be taken to the OR and prepared for an emergent immediate delivery by c-section. It is important to remember that the baby can never deliver after the umbilical cord or placenta. That umbilical cord and placenta are the life line.