Critical Procedure - Umbilical cord prolapse

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For all procedures, ask yourself, 'does this need to be done 'now vs later'? And should this be done by 'me vs someone else?' Very often the answers will be 'now' and 'me' - so read on!

Umbilical cord prolapse

Description

This is an immediate obstetric emergency.

Indications

Overt and occult umbilical cord prolapse. 
Overt -  umbilical cord either extrudes through the introitus or can be palpated in the vagina.
Occult - umbilical cord may be palpable next to the presenting part or the only sign may be CTG trace changes.

Contraindications

 

Equipment

Gloves.
Hands.
Urinary catheter (to fill, not empty bladder).

Procedure

Call for help and a stat C-section

Replace the cord in the vagina.  Minimise handling of the cord.

Check for cord pulsation.

Push the presenting part up, to take pressure off the cord.

Maternal position, either:

  • 'All fours' - get mother onto her knees and elbows/forearms with her knees up to her chest and her chest close to the bed.
  • 'Left lateral Trendelenburg' - mother on her left side in a head down position.


During emergency ambulance transfer the 'all fours' position is unsafe and the left lateral Trendelenburg should usually be preferred.
Consider filling the bladder with 500mls of sterile saline which pushes up on the presenting part.

Consider tocolysis if awaiting C-section - seek advice.
Consider assisted vaginal delivery if the cervix is fully dilated and delivery is imminent. Vaginal delivery, within 20 minutes, in these circumstances has at least as good outcomes as C-section.

Potential pitfalls

Any delay.

"Plan B"

Vaginal delivery.  Consider and episiotomy and vacuum extraction minimise delivery time.

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Last modified: Friday, 14 August 2020, 1:12 PM