Umbilical cord prolapse: Difference between revisions
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'''Cord prolapse''' is an [[obstetrics|obstetric]] emergency during [[pregnancy]] or labour that endangers the life of the fetus. It occurs when the [[umbilical cord]] presents itself outside of the [[uterus]] while the [[fetus]] is still inside. It can happen when the water breaks – with the gush of water the cord comes along. Usually, thereafter the fetus will engage and squash the cord, cutting off oxygen supplies and leading to [[brain damage]] of the fetus, or [[stillbirth]]. Before that happens, the baby must be delivered quickly by [[caesarean section]]. In the meantime, the woman adopts the knee-elbow position, and an attendant reaches into the [[vagina]] and pushes the presenting part (usually the head) back in so that it does not suffocate the cord. It is useless to try to push the cord back in. Another technique is to infuse 500ml of fluid by catheter into the mother's bladder, in order to displace the presenting part upward, and to reduce compression on the prolapsed cord. | '''Cord prolapse''' is an [[obstetrics|obstetric]] emergency during [[pregnancy]] or labour that endangers the life of the fetus. It occurs when the [[umbilical cord]] presents itself outside of the [[uterus]] while the [[fetus]] is still inside. It can happen when the water breaks – with the gush of water the cord comes along. Usually, thereafter the fetus will engage and squash the cord, cutting off oxygen supplies and leading to [[brain damage]] of the fetus, or [[stillbirth]]. Before that happens, the baby must be delivered quickly by [[caesarean section]]. In the meantime, the woman adopts the knee-elbow position, and an attendant reaches into the [[vagina]] and pushes the presenting part (usually the head) back in so that it does not suffocate the cord. It is useless to try to push the cord back in. Another technique is to infuse 500ml of fluid by catheter into the mother's bladder, in order to displace the presenting part upward, and to reduce compression on the prolapsed cord. | ||
==Risk | ==Risk Factors== | ||
Potential predisposing risk factors include: | Potential predisposing risk factors include: | ||
*[[Premature birth|Premature]] rupture of the [[amniotic sac]] | *[[Premature birth|Premature]] rupture of the [[amniotic sac]] | ||
| Line 12: | Line 12: | ||
*long umbilical cord | *long umbilical cord | ||
== Prognosis == | == Natural History, Complications and Prognosis == | ||
The [[mortality rate]] for the fetus is given as 11-17%<ref>http://www.gpnotebook.co.uk/simplepage.cfm?ID=1785397303 GP Notebook. Mortality 11-17%.</ref>. This applies to hospital births or very quick transfers in a first world environment. One series is reported where there was no mortality in 24 cases with the novel intervention of infusing 500ml of fluid by catheter into the bladder, in order to displace the presenting part upward and reduce compression on the prolapsed cord. | The [[mortality rate]] for the fetus is given as 11-17%<ref>http://www.gpnotebook.co.uk/simplepage.cfm?ID=1785397303 GP Notebook. Mortality 11-17%.</ref>. This applies to hospital births or very quick transfers in a first world environment. One series is reported where there was no mortality in 24 cases with the novel intervention of infusing 500ml of fluid by catheter into the bladder, in order to displace the presenting part upward and reduce compression on the prolapsed cord. | ||
==Treatment== | ==Treatment== | ||
====Contraindicated medications==== | |||
{{MedCondContrAbs|MedCond = Umbilical cord prolapse|Oxytocin}} | |||
===Surgery=== | |||
Some practitioners will attempt to reduce pressure on the cord and deliver vaginally right away. Frequently the attempt to resolve the prolapsed cord and deliver the baby vaginally fails, and an emergency [[caesarean section]] must be performed immediately.<ref>http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijgo/vol1n1/cord.xml</ref> While the patient is being prepared for a caesarean, the woman is placed in the [[Trendelenburg position]] or the knee-elbow position,<ref>http://www.patient.co.uk/showdoc/40000243/</ref> 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.<ref>http://books.google.com/books?id=fAf1wCTRRCUC&pg=PA234&lpg=PA234&dq=cord+prolapse+management&source=web&ots=Lgdg1LLvtj&sig=9osvwQy00PHO4PTaBJ6Vn-liUZM&hl=en&sa=X&oi=book_result&resnum=6&ct=result</ref> If attempts to deliver the baby promptly fail, the fetus' oxygen and blood supply are occluded and brain damage or death will occur. | Some practitioners will attempt to reduce pressure on the cord and deliver vaginally right away. Frequently the attempt to resolve the prolapsed cord and deliver the baby vaginally fails, and an emergency [[caesarean section]] must be performed immediately.<ref>http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijgo/vol1n1/cord.xml</ref> While the patient is being prepared for a caesarean, the woman is placed in the [[Trendelenburg position]] or the knee-elbow position,<ref>http://www.patient.co.uk/showdoc/40000243/</ref> 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.<ref>http://books.google.com/books?id=fAf1wCTRRCUC&pg=PA234&lpg=PA234&dq=cord+prolapse+management&source=web&ots=Lgdg1LLvtj&sig=9osvwQy00PHO4PTaBJ6Vn-liUZM&hl=en&sa=X&oi=book_result&resnum=6&ct=result</ref> If attempts to deliver the baby promptly fail, the fetus' oxygen and blood supply are occluded and brain damage or death will occur. | ||
Latest revision as of 18:09, 10 December 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Cord prolapse is an obstetric emergency during pregnancy or labour that endangers the life of the fetus. It occurs when the umbilical cord presents itself outside of the uterus while the fetus is still inside. It can happen when the water breaks – with the gush of water the cord comes along. Usually, thereafter the fetus will engage and squash the cord, cutting off oxygen supplies and leading to brain damage of the fetus, or stillbirth. Before that happens, the baby must be delivered quickly by caesarean section. In the meantime, the woman adopts the knee-elbow position, and an attendant reaches into the vagina and pushes the presenting part (usually the head) back in so that it does not suffocate the cord. It is useless to try to push the cord back in. Another technique is to infuse 500ml of fluid by catheter into the mother's bladder, in order to displace the presenting part upward, and to reduce compression on the prolapsed cord.
Risk Factors
Potential predisposing risk factors include:
- Premature rupture of the amniotic sac
- polyhydramnios (having too much amniotic fluid) the cord may be forced out with the more forceful gush of waters
- long umbilical cord
Natural History, Complications and Prognosis
The mortality rate for the fetus is given as 11-17%[1]. This applies to hospital births or very quick transfers in a first world environment. One series is reported where there was no mortality in 24 cases with the novel intervention of infusing 500ml of fluid by catheter into the bladder, in order to displace the presenting part upward and reduce compression on the prolapsed cord.
Treatment
Contraindicated medications
Umbilical cord prolapse is considered an absolute contraindication to the use of the following medications:
Surgery
Some practitioners will attempt to reduce pressure on the cord and deliver vaginally right away. Frequently the attempt to resolve the prolapsed cord and deliver the baby vaginally fails, and an emergency caesarean section must be performed immediately.[2] While the patient is being prepared for a caesarean, the woman is placed in the Trendelenburg position or the knee-elbow position,[3] 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.[4] If attempts to deliver the baby promptly fail, the fetus' oxygen and blood supply are occluded and brain damage or death will occur.
References
- ↑ http://www.gpnotebook.co.uk/simplepage.cfm?ID=1785397303 GP Notebook. Mortality 11-17%.
- ↑ http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijgo/vol1n1/cord.xml
- ↑ http://www.patient.co.uk/showdoc/40000243/
- ↑ http://books.google.com/books?id=fAf1wCTRRCUC&pg=PA234&lpg=PA234&dq=cord+prolapse+management&source=web&ots=Lgdg1LLvtj&sig=9osvwQy00PHO4PTaBJ6Vn-liUZM&hl=en&sa=X&oi=book_result&resnum=6&ct=result
Template:Certain conditions originating in the perinatal period