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found my old OSCE notes and thought I'd post them here.

These are the cord prolapse ones, if


you think they'd be useful shout and I'll put up the other topics
Cord prolapse occurs, after the membranes have ruptured, when the umbilical cord
presents in front of or alongside the fetus (occurs 3 in 1,000 deliveries). Prior to the
membranes rupturing it is called a funic presentation. (occurs in 12-25 in 10,000
pregnancies) - Boyle & Katz (2005)
There are two types of cord prolapse:

and
Overt/frank cord prolapse Occult cord prolapse
(cord into (or hanging out of) the vagina) (cord alongside the fetus)
There are three ways of discovering cord prolapse:

See it Hear it Feel it


(hanging out of the vagina) (decelerations or bradycardia) (On VE)
Who is at highest risk?

Prematurity

IUGR
Breech
Transverse Lie
Multiple pregnancy (especially twin 2)
High parity
Non-engagement of head
Polyhydramnios
Artifical Rupture of Membranes
ECV

Treatment when discovered


Call for help
Senior obstetrician
Obstetrician to assist (potential caesarean section)
Anaesthetist
ODP
Senior midwife
Scribe
Paediatrician
Inform SCBU
Explain to woman and partner all along
Relieve cord compression
Place woman into position to take gravity away from cervix

Exaggerated Sims
Knee chest put wedge/pillow under the hip
Apply digital pressure to keep presenting part off cervix
Handle cord as little as possible, but replace into vagina if hanging out
Ascertain fetal viability
If cord pulsating then alive
If fetal heart tones heard then alive (monitor if possible)

If neither check with ultrasound scan (occasionally heart movement later)


If fetus alive

Check dilation if fully dilated and low head then instrumental (or multip may proceed
quickly to SVD)
Crash caesarean section (usually under GA see contentious issues)
2 large bore venflons to be sited (+ bloods)
catheterise
maintain digital pressure until birth of baby
Have paediatrician ready, due to high chance of resuscitation following hypoxia
Take cord blood gases after birth to assess hypoxia
If intrauterine death
Proceed with vaginal birth
Explain to parents
Offer usual care for stillbirths
Record Keeping, as contemporaneously as possible, when writing up notes include original
scribes transcripts
Contentious issues

Vago first suggested bladder filling in 1970. A no. 16 Foley catheter is placed in the
maternal bladder, and filled with 400-750mls of normal saline. This is then clamped
and not released till ready for knife to skin. The full bladder can inhibit uterine
contractions and displace presenting part from the pelvis. Katz & Shoham (1988)
found in their 5 year study (n=51) that there were NO perinatal deaths and only 8
continued fetal distress (pre bladder filling, 33 )
If there is no fetal distress and/or pressure on the presenting part (ie transverse

position) or woman has an effective epidural is there a need for a GA? Due to increased
maternal mortality (3 deaths in last Why mothers Die from GA complications)
Homebirths if woman is upstairs needs to get downstairs as fast as possible, to reduce
pressure on cord fastest way is probably for her to go down the stairs normally as
quickly as she can, then resume knee chest/sims position. For this reason many midwives
recommend homebirths are on the ground floor. Transfer in ambulance should be in
exaggerated sims