Component Task: Management of Cord Prolapse

This is an acute obstetric emergency care given by the midwife to the mother/client when the cord is felt in the lower uterine segment either adjacent or below the presenting part after rupture of the membranes.

Aims

·         Relieve cord compression from the presenting part

·         Prevent vasospasms of the umbilical cord

·         Assess viability of the foetus

·         Prevent foetal hypoxia

·         Reduce chorioamnionitis

·         Reduce neonatal morbidity and mortality

Requirements

a.      Vagina examination tray

b.      Vital signs tray

c.      Resuscitaire

d.      Oxygen apparatus

e.      Face mask/nasal prongs

f.        Big sterile gauze

g.      Jug with warm water

h.      Foetal monitor (manual/electronic)

i.         Surgical gloves

j.         Shaving stick

k.       Intravenous cannula

l.         Intravenous fluids

m.   Giving sets

n.      Gown and head cap

o.      Patient’ s Records

p.      Identification band

q.      Signed consent form

r.        Urethral catheter, urine bag and stopper

s.       Cord clamp/ligature

Steps

1.        Establish rapport (refer steps)

2.      Explain procedure to client (refer steps)

3.      Perform hand hygiene and don examination gloves

4.      Administer oxygen by face mask or nasal prongs

5.      Perform hand hygiene and don sterile gloves

6.      Perform vaginal examination to diagnose cord prolapse and determine dilatation of the cervix (and stage/phase of labour)

7.       Check for pulsations in the cord

8.      Analyse information gathered from physical examination and the partograph/WHO labour care chart (stage and phase of labour, presentation and position of the foetus, condition of woman and foetus)

9.      Make a decision about management based on: if the woman is in first or second stage of labour, if the foetus is alive or dead, if the presentation is cephalic or breech

10.    Arrange for evacuation and inform doctor if the woman is in first stage of labour and the cord is pulsating

11.      Wear sterile gloves, insert a hand into the vagina and push the presenting part up to decrease pressure on the cord and dislodge the presenting part from the pelvis

12.    Place the other hand on the abdomen in the suprapubic region to keep the presenting part out of the pelvis

13.    Inflate the bladder with 500 to 700 ml of normal saline once the presenting part is firmly held above the pelvic brim

14.    Adjust maternal position (Knee-chest)

15.    Cover cord with surgical packs soaked in warm saline

16.    Set IV fluids to run slowly

17.    Administer Tocolytics (e.g. Salbutamol 0.5mg IV slowly over 2 minutes to reduce contractions)

18.    Prepare for immediate Caesarean operation

19.    Prepare for delivery or assisted delivery if client is in a second stage of labour and the cord is pulsating

20.  Perform episiotomy if necessary to expedite delivery

21.    Seek obstetrician assistance immediately if breech presentation and the cord is pulsating

22.  Prepare for breech extraction

23.  Assess and resuscitate baby immediately after delivery

24.  Deliver in the manner that is safest for the client if cord is not pulsating

25.  Communicate progress of management to client and family

26.  Maintain Infection, Prevention and Control measures throughout management

27.  Perform hand hygiene

28.  Dispose and decontaminate used items

29.  Record and report all information in the Maternal and Child Health Book (Manual or Electronic)

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