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Cord Prolapse




Description
  1. Cord prolapse is descent of the umbilical cord into the vagina ahead of the fetal presenting part with resulting compression of the cord between the presenting part and the maternal pelvis.
  2. Cord prolapse is an emergency situation; immediate delivery will be attempted to save the fetus.
  3. It occurs in 1 of 200 pregnancies.

Etiology
  1. This problem occurs most frequently in prematurity, rupture of membranes with the fetal presenting part unengaged, and shoulder or footling breech presentations.
  2. It may follow rupture of the amniotic membranes because the fluid rush may carry the cord along toward the birth canal.

Pathophysiology
  • Compression of the cord results in the compromise or cessation of fetoplacental perfusion.

Assessment Findings


1. Associated findings
  • Cord prolapse may be occult or occur at any time in the labor process, even when the amniotic membranes are intact.
  • Client reports feeling the cord within the vagina.
2. Clinical manifestations
  • Fetal bradycardia with deceleration during contraction.
  • The umbilical cord can be seen or felt during a vaginal examination.

Nursing Management

1. Identify prolapse cord and provide immediate intervention.
  • Assess a laboring client often if the fetus is preterm or small for gestational age, if the fetal presenting part is not engaged, and if the membranes are ruptured.
  • Periodically evaluate FHR, especially right after rupture of membranes (spontaneous or surgical), and again in 5 to 10 minutes.
  • If prolapse cord is identified, notify the physician and prepare for emergency cesarean birth.
  • If the client is fully dilated, the most emergent delivery route may be vaginal. In this case, encourage the client to push and assist with the delivery as follows.
    • Lower the head of the bed and elevate the client’s hips on a pillow, or place the client in the knee-chest position to minimize pressure from the cord.
    • Assess cord pulsations constantly.
    • Gently wrap gauze soaked in sterile normal saline solution around the prolapsed cord.
2. Provide physical and emotional support.

3. Provide client and family education.
Figure 2 Measures that may be used to relieve pressure on a prolapsed umbilical cord until delivery can take place.







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