Umbilical Cord ProlapseLucy Pettit

Aims

Provide information and practical guidance to

enable early diagnosis and efficient initiation of

emergency procedures to ensure the best possible

neonatal outcome

Definition

Overt prolase, the more common of the two, involves protrusion of the umbilical cord past the presenting part and into or out of the vagina

Definition

Occult prolapse, on the other hand, occurs when the cord descends alongside but not past the fetal presenting part; it's not always palpable on digital examination. Occult prolapse can occur even when fetal membranes remain intact.

Objectives

Identify predisposing risk factors Enable prompt diagnosis and institute

immediate action Initiate correct emergency procedures Raise awareness of the neonatal

implications

Predisposing factors Multiple pregnancy

High presenting part

Polyhydramnios

Premature labour

Malpresentations

Fetal abnormalities

Uterine abnormalities

Management

Fetal survival depends on swift action Call for help – midwifery colleagues/8000 Factors to consider:

Viability of fetusSevere fetal abnormalities

Emergency delivery for a normally formed and mature fetus

First stage of labour

Emergency LSCSTake measures to optimise fetal well-being

(maternal positioning)Multidisciplinary approachTeamwork

Second stage of labour Vaginal delivery

Depends on descent of head & rate of progress; parity

Instrumental delivery Depends on skill levels & confidence; descent of head

& rate of progress. Not a midwifery decision

Caesarean section Take measure to ensure to optimise fetal well-being Multidisciplinary approach Teamwork

Emergency procedures

Elevation of the presenting part:Digital pressureKneeling on all fours, buttocks uppermost, orExaggerated Sims (left lateral)Fill bladder with 500mls salineTocolysis

Do’s & Don'ts

DO Replace the cord

into the vagina Monitor the fetal

HR Inform the woman

DON’T Replace the cord

inside the uterus Handle the cord

excessively

Mnemonic

Call for help

Organise delivery

Relieve pressure on the cord

Deliver

Emergency ChecklistEmergency Checklist Cord Presentation/ Prolapse

Bradma

Procedure Date_____________

Emergency Bell

8000 obstetric emergency call made

EXAMINER performing VE protects cord from compression by remaining in position

Woman moved to knee/chest or exaggerated left lateral position

Check fetal heart rate and assess uterine activity

Commence maternal oxygen

Notify theatre of need for immediate caesarean section

Ensure Paediatrician attends main theatre

Move woman to theatre on delivery bed

Documentation Photocopy this checklist and place in patient’s notes with patient label on top of page. Use as reference for more detailed clinical notes. Remember to sign the copy for the clinical notes Please wipe clean checklist once copied and return to delivery room

Times …………….

……………. ……………. ……………. ……………. ……………. ……………. ……………. ……………. ……………. …………….

Names of practitioners

present