UMBILICAL CORD PROLAPSE

Umbilical cord prolapse happens when the umbilical cord precedes the fetus' exit from theuterus. It is an obstetric emergency during pregnancy or labor that imminently endangers the life of the fetus. Cord prolapse is rare. Statistics on cord prolapse vary, but the range is between 0.14% and 0.62% of all births with perinatal mortality ranging between 36 and 345 per 1,000 births. Cord prolapse 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. *There are two types of cord prolapse:
1.

Overt prolapse, which is the most common, refers to protrusion of the cord in advance of the fetal presenting part, often through the cervical os and into or beyond the vagina. The fetal membranes are invariably ruptured in these cases and the cord is visible or palpable on examination.

2.

Occult prolapse occurs when the cord descends alongside, but not past, the presenting part. It can occur with intact or ruptured membranes. The diagnosis should be considered in the differential diagnosis of a sudden, prolonged fetal heart rate deceleration. An occult prolapse often cannot be diagnosed with certainty, but is suggested by clinical features (eg, fetal bradycardia) and findings at cesarean delivery

RISK FACTORS:

Fetal malpresentations Premature infants Multiparous women

CAUSES:
A fetus that remains at a high station A very small fetus Breech presentations. The footling breech is more likely to be complicated because the feet and the legs are small and do not fill well the pelvis. Transverse lie

Polyhydramnios Excessive amniotic fluid Premature rupture of the membranes Placenta previa Intrauterine tumors preventing the presenting part from engaging CPD preventing firm engagement Multiple gestation Delivering more than one baby per pregnancy (twins, triplets, etc.) Premature delivery of the baby An umbilical cord that is longer than usual

SIGNS:

A loop of cord is felt in vagina or may be seen at the vulva. Fetal bradycardia (sustained) with deceleration (variable) during contraction Client reports feeling the cord within the vagina Umbilical Cord palpated on pelvic exam Can also be diagnosed on Ultrasound.

PATHOPHYSIOLOGY:
Precipitating factors: >Fetal malpresentations >Premature infants >Polyhydramnios >Placenta previa >Premature rupture of the membranes >CPD >Multiple gestation >umbilical cord that is longer than usual poor fit between the fetal presenting part and the maternal bony pelvis allow the cord to prolapse cord compression and umbilical arterial vasospasm obstruction of venous and arterial blood flow to and from the fetus

blood and oxygen supply is cut off fetal distress and asphyxia

ANATOMY AND PHYSIOLOGY:

The umbilical cord is a flexible, tube-like structure that, during pregnancy, connects the fetus to the mother. The umbilical cord is the babys lifeline to the mother. It transports nutrients to the baby and also carries away the babys waste products. It is made up of three blood vessels two arteries and one vein.

COMPLICATIONS:
prematurity congenital malformations death

PROGNOSIS:
Depends upon fetal condition at thetime of diagnosis, status of thecervix, and appropriate intervention.

GENERAL MANAGEMENT: (Medical and Nursing Management)

- >Its an emergency situation and an indication for immediate Caesarean Section if baby is alive and vaginal delivery cannot be effected,immediately. The aim of management is to prevent the presenting part from occluding the cord.

T o c o l y s i s w i t h T e r b u t a l i n e 0 . 2 5 m g S C - 2-adrenergic receptor agonist that stops theuterine contractions, relieving pressure on the cord; suppresses premature labor. Contraindication-cardiac arrhythmias

Emergent Cesarean Section; Vaginal delivery only if imminent.

Deliver as Intrauterine Fetal Demise (stillbirth) if fetus has died (Check for cord pulsations,check for fetal heart sounds, and obstetric ultrasound to assess heart activity).

Pre-hospital cord prolapse noted at home by patient (Let patient assume a deep kneechest position because it may relieve enough pressure on the umbilical cord and tp promote oxygenation to the fetus)

cover cord with warm saline dressing to protect the exposed cord and to prevent infection

While the patient is being prepared for a caesarean, the woman is placed in the Trendelenburg position or the knee-elbow position, and an attendant reaches into the vagina and pushes the presenting part out of the pelvic inlet and back into the pelvis to remove the pressure from the umbilical cord

Infusion of 500ml warm saline in bladder through 16 size catheter may be an alternative. The cord is kept in the vagina to keep it warm and moist to prevent arteries going into spasm

PREVENTION:
>During antenatal period patients should be counselled to report hospital if leaking occurs,with or without contractions. >Amniotomy should ONLY be done when the presenting part is fixed.

FIRST ASIA INSTITUTE OF TECHNOLOGY AND HUMANITIES

(Umbilical Cord Prolapse)

Submitted by: Maria Cecilia C. Delos Reyes

CASE REPORT

BSN IV-A

Submitted to: Mrs. Vangie Hernandez, RN, MAN Clinical Instructor (Delivery roomBRH)