Cord prolpase for undergraduate
-
Upload
faculty-of-medicinezagazig-universityegypt -
Category
Education
-
view
1.763 -
download
0
description
Transcript of Cord prolpase for undergraduate
![Page 1: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/1.jpg)
![Page 2: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/2.jpg)
Definition
Cord Presentation: Cord in front of presenting part before the rupture of membranes
Cord Prolapse: Cord in front of presenting part after rupture of
membranes
![Page 3: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/3.jpg)
![Page 4: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/4.jpg)
Cord presentation vs. Cord prolapse
![Page 5: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/5.jpg)
Occult cord prolapse
• Cord lying alongside the presenting part• Occult vs. presentation vs. prolapsed cord
![Page 6: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/6.jpg)
IncidencePrimigravida 0.45%Multigravida 0.66% (Risk ratio 2:3)Cephalic 0.3%Frank breech 0.9%Complete breech 5%Footling 10%Shoulder 15%Contracted pelvis 4-6 times
![Page 7: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/7.jpg)
CausesMalpresentation - face, brow, breech and shoulderPrematurityPolyhydramniosMultiple pregnancyLong cord (90-100 cm)PROMCPDObstetric interventions - Amniotomy, Intrauterine
pressure catheter, scalp electrode, external cephalic version,
![Page 8: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/8.jpg)
Dangers• Mortality rate as high as 50%• Hypoxia• Spasm of vessels• Operative trauma to suboxgenated
fetus
![Page 9: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/9.jpg)
DiagnosisCord pulsations
CTG shows variable decelerations Fundal pressure causes bradycardiaMeconium stained liquor
![Page 10: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/10.jpg)
US – cord loops Cord outside vulva
![Page 11: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/11.jpg)
Prevention1. Do US for malpresentation and cord
presentation
2.FHR monitoring
3.Avoid ARM in an unengaged head
4.PV exam after ROM
![Page 12: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/12.jpg)
ManagementLift presenting part off the cord Instruct patient NOT to push Position 1. Knee chest
2. Trendelenburg
3.Exaggerated position
![Page 13: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/13.jpg)
Knee chest position
![Page 14: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/14.jpg)
Trendelenburg position
![Page 15: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/15.jpg)
Exaggerated sim’s position
![Page 16: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/16.jpg)
Management (cont..)• Vulval pad• Replacement of cord• Tocolysis (ritodrine)Funic ReductionManual replacement of cord into uterusCord gently pushed above presenting
part while other cord decompression techniques are applied
![Page 17: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/17.jpg)
Stage II Labor:
- Expedite delivery with episiotomy and vacuum extraction or forceps
Prepare for resuscitation of the newborn.
![Page 18: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/18.jpg)
Fetal Mortality• Overall - 50%• 1st stage of labour - 70%• 2nd stage of labour -30%• Neonatal death - 4%• Perinatal mortality- 20%
Fetal Mortality
![Page 19: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/19.jpg)
Fetal Mortality• More with vertex than breech
• More with anterior than posterior.
• More in prime than multi
• < 5 minutes, prognosis good, > 5 mins, damage and death.
•
Prognosis
![Page 20: Cord prolpase for undergraduate](https://reader033.fdocuments.in/reader033/viewer/2022061606/55664ad9d8b42a3b398b4eae/html5/thumbnails/20.jpg)
THANK YOU THANK YOU