CORD PROLAPSE

I. DEMOGRAPHIC DATA :

Name of the patient: Lapoot Paz Age: 21 years old Address: Poblacion Lila Bohol Status: Married Pre-op Diagnosis: G1P0 39 weeks AOG Cephalic in Labor Post-op Diagnosis: G1P1 (1001) Pregnancy Uterine 40 weeks Age of Gestation, Cephalic Fetal Distress due to Cord Prolapsed

II.

DEFINTION Umbilical cord prolapse is a rare obstetrical emergency that occurs when the umbilical cord descends alongside or beyond the fetal presenting part. It is life-threatening to the fetus since blood flow through the umbilical vessels is usually compromised from compression of the cord between the fetus and the uterus, cervix, or pelvic inlet.

III.

PATHOPHYSIOLOGY There are numerous risk factors for a cord prolapse leading to several pathophysiologies. It is important to understand the structure and function of the umbilical cord to understand why a cord prolapse is an emergency. The umbilical cord consists of an umbilical vein which carries oxygenated blood, and 2 umbilical arteries that return deoxygenated blood (in a normal 3 vessel cord). The umbilical vein is thin walled and especially susceptible to compression. At higher pressures the arteries will also be compressed. The decreased in blood flow triggers baroreceptors causing vagal stimulation which causes decelerations (lower heart rate). Chemoreceptors can sense hypoxemia and thus may raise the baseline heart rate to a tachycardic range.

If the presenting part does not fill the entire cervix there is room for the cord to descend, hence the highest risk is in a footling breech (where the foot is the presenting part). Prematurity and multiple gestation confer a higher risk of breech and therefore higher risk of cord prolapse. Additional factors that cause the presenting part to not be fully engaged when the rupture of membranes occur and the cord is at risk for descent are PROM (which is more likely in multiparous), obstetrical interventions that can disengage the presenting part, placenta previa or low lying placenta, and a large pelvic mass or deformity. A complete previa would prevent overt prolapse; however, occult prolapse can still occur. IV. CAUSES/RISK FACTORS Cord prolapsed is often concurrent with the rupture of the amniotic sac. After this happens the fetus moves downward into the pelvis and puts pressure on the cord. As a result, oxygen and blood supplies to the fetus are diminished or cut-off and the baby must be delivered quickly V. Premature Birth Multiple births (eg, twins, triplets) Excessive amounts of amniotic fluid (polyhydramnios) Breech delivery (feet first) Abnormally long umbilical cord

SIGNS AND SYMPTOMS If the cord slips down into the vagina, you may actually be able to feel it or even see it. If the cord is compressed by the baby's head, the baby will show signs of fetal distress on a fetal monitor.

VI.

DIAGNOSIS Heart rate monitoring of the mother and baby Pelvic examination to see and feel the umbilical cord present in the vagina

VII.

NURSING MANAGEMENT

1. Identify prolapsed cord and provide immediate intervention.

y Assess a labouring 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.
y Periodically evaluate FHR, especially right after rupture of membranes

(spontaneous or surgical), and again in 5 to 10 minutes.

y If prolapsed cord is identified, notify the physician and prepare for emergency

caesarean birth.
y If the client is fully dilated, the most emergent delivery route may be vaginal. In

this case, encourage the client to push and assist with the delivery as follows.
o

Lower the head of the bed and elevate the clients hips on a pillow, or place the client in the knee-chest position to minimize pressure from the cord.

o o

Assess cord pulsations constantly. Gently wrap gauze soaked in sterile normal saline solution around the prolapsed cord.

Apply oxygen at 10 to 12 L/minutes - Apply firm upward manual pressure to the presenting part of the fetus and relieve pressure from the cord. - Assess cord pulsations constantly

2. Provide physical and emotional support. 3. Provide client and family education.

CASE STUDY
(CORD PROLAPSE)

Submitted to: Vladimir Avenido

Clinical Instructor

Submitted by: Cleta C. Escabarte

BSN 4H