Chapter: Obstetric and Gynecological Nursing : Abnormal Labour

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Prolapse of Cord

Prolapse of umbilical cord can be classified as: · Occult prolapse in which the cord lies over the face or head of the fetus but can not be felt on vaginal examination

Prolapse of Cord

 

Prolapse of umbilical cord can be classified as:

 

·        Occult prolapse in which the cord lies over the face or head of the fetus but can not be felt on vaginal examination

 

·        Foreying in which the cord precedes the presenting part and usually palpated through the membranes if the cervix is dilated

 

·        Complete prolapse in which the cord deceds in to the vagina in front of the presenting part

 

Obstetric factors which favors prolapse of ublical cord are:

 

-                  Abnormal presentation (Face,Breech, Shoulder, Brow and Transverse)

 

-                  Multiple pregnancy

 

-                  Premature rupture of membrane prior to engagement of the presenting part

 

-                  Contracted pelvis

 

-                  Hydraminous

 

-                  Low implantation of placenta

 

-                  Abnormally long cord

 

 

Manegement: - It depends on the fetal condition andpresentation.

If the fetus is alive:

 

-                  Position the mother in the knee chest position or deep trendelenberg position

 

-                  Manually pushing the presenting part backward by gloved finger vaginally to relieve off the pressure on the cord till the baby is delivered

 

-                  The best method of delivery in this case is caesarean section

 

-                  If the fetus is not alive and the presentation and position is normal vaginal delivery is possible

 

Complications

 

Fetal

 

·        Birth trauma

 

·        Prematurity

 

·        Metabolic acidosis

 

·        Hypoxia

 

 

Maternal

 

·        Lacerations of birth canal if rapid vaginal delivery is carried out

·        Rupture of uterus (malpresentations)

·        Uterine atony (prolonged labour)

 

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