UMBILICAL CORD PROLAPSE

GROUP 3

What is umbilical cord prolapsed?

Umbilical cord prolapsed
- is a complication that occurs prior to or during delivery of the baby.
-this most often occurs after the membranes have ruptured and the baby
moves into the birth canal for delivery.

Types of umbilical cord prolapsed

1.Overt prolapsed it is when the cord is below the presenting fetal part ,
usually through the cervical os into or through the vagina. Loops of the cord
are palpable on pelvic exam or are visually protruding through the introits.
Rupture of membranes is a prerequisite for overt prolapsed.

2.Occult prolapsed- it is when the cord lies alongside the presenting part.
The membranes may be intact or ruptured. This type of prolapsed is often
more difficult to detect, and is rarely palpated. Occult prolapsed is usually
detected by fetal heart changes associated with cord compression.

Nursing management

*monitor fatal heart rate

*initiate intrauterine resuscitation
*prepare for emergency delivery by the most rapid and safe route, which is
typically CS
*minimize manipulation of the cord and exposure of the cord to a dry cool
environment

*if cord prolapsed is suspected, perform a vaginal examination to determine:

-cervical length / effacement / dilatation
-station of the presenting part
*if cord prolapsed is confirmed (cord palpated), call for assistance, stay with
the woman:
-position the woman head down with hips elevated (in knee chest, modified
sims or trendelenburg)

-keep gloved hand in the vagina (or insert gloved hand into vagina if not already
performing digital
vaginal exam) and exert upward pressure on the fetal
presenting part to stop compression of the cord.
-keep hand in position until delivery or orders received
*if you can see cord protruding in the vagina
-do not attempt to replace cord above the presenting part
-wrap cord loosely in sterile towel saturated with warm, sterile normal saline

*continue to effectively communicate with the woman and her support

person(s.)

Causes of umbilical cord prolapsed

*premature rupture of membranes
*fetal presentation other than cephalic
*placenta previa
*hydramnios
*multiple gestation

Maternal and fetal complications

*gestational diabetes
*preeclampsia
*bleeding or spotting
-miscarriage
-ectopic pregnancy
*placenta previa
*abruptio placenta

PATHOPHYSIOLOGY

There are numerous risk 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 emergency!
UMBILICAL CORD

The umbilical cord consist vein which carries oxygenated blood , and 2
umbilical arteries that return deoxygenated blood

The umbilical vein is thin walled and especially susceptible to compress

At the higher pressure the arteries will also compressed.

The decreased in blood flow triggers baroreceptors causing vagal stimulation

which causes decelerations (LOW HEART RATE).
Chemoreceptors can sense hypoxemia and thus may raise the baseline heart
rate tachy cardic range
HYPOXEMIA
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)
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.
Complete placenta previa
Polyhydramnios
as a risk factor is thought to be related to the large volume of amniotic fluid
that flows out when the membranes rupture, the force then pushes the cord
down
Polyhydramnios
Prematurity
Prematurity as a risk factor could also be related to a relative polyhydramnios
compared to the size of the fetus.