OSCE: Cord Prolapse

Nuchal cord

Umbilical cord wrapped around fetal neck

cord avulsion

snapping of cord

Clamp neonatal site

Observe signs of shock

Cord presentation

umbilical cord between fetal presenting part + cervix

cord prolapse

umbilical cord descend through cervix → vagina w/ ruptured membranes

Types of cord prolapse

Occult: alongside presenting part

Overt: over/past the head

CORD

C→ consider

O→ recognise help

R→ relieve pressure

D→ decision for birth

Prevention

Awareness, anticipation and knowledge of risk factors

Only do ARM if head is well flexed and engaged

Cord prolapse steps

on VE you may feel cord (pulsating)

DO NOT remove fingers

shout CORD/CORD PROLAPSE

Ask someone to put out emergency bleep 222 CAT 1 ? FHR pattern w/ out compromise to maternal wellbeing, CAT 2 FHR is normal

If epidural disc immediately

No epidural, ask woman to move knee to chest to raise head and alleviate pressure from the cord

Try keep pressure on head to push up from cord

Move w/ woman onto trolley for CS keep fingers in until obstetrician make contact w/ baby abdominally (until baby is out)

What should u do if cord is outside vagina?

try once to reinsert cord, if it fails do not reattempt to avoid handling cord