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Umbilical Cord Prolapse
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Prasantha Wijesinghe
Awareness about the risk of umbilical cord prolapse in the presence of risk factors should prevent this complication from occurring. Women with abnormal fetal lie, e.g. transverse, oblique or unstable, should be advised immediate admission to a hospital in case of the onset of labour or rupture of membranes, because prelabour rupture of membranes, especially in the presence of a high presenting part, carries a high risk of umbilical cord prolapse. A sterile speculum examination is indicated in the presence of ruptured membranes, especially with any evidence of fetal heart rate abnormalities, to exclude umbilical cord prolapse. Amniotomy should be avoided in the presence of a high presenting part, and if it is absolutely necessary, a stabilising induction should be performed. Stabilising induction entails commencing an oxytocin infusion to initiate uterine contractions, performing amniotomy once uterine contractions are established and releasing liquor slowly while an assistant stabilises the presenting part over the pelvis, stabilising the presenting part at the pelvis for some time until the presenting part descends further and maintaining uterine contractions with the oxytocin infusion.
Examination B
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, The New DRCOG Examination, 2017
Aalia Khan, Ramsey Jabbour, Almas Rehman
Cord prolapse has been defined as the descent of the umbilical cord through the cervix alongside (occult) or past the presenting part (overt) in the presence of ruptured membranes. Fetal compromise occurs as the cord is exposed to the cold and undergoes vasospasm. Also, the cord will be compressed during contractions if in labour. Abnormal lie is associated with cord prolapse, breech 10% and transverse lie up to 20%. Cord prolapse is uncommon, with an incidence between 1 and 6/1000 deliveries. It is an obstetric emergency. It may be indicated by variable decelerations on the CTG. The mother should be placed in the knee-chest position, pressure should be placed on the presenting part to move it away from the cord and arrange delivery by emergency Caesarean section as soon as possible.
Single best answers: obstetrics
Published in Janice Rymer, Norman Smith, Obstetrics and Gynaecology for Finals, DRCOG and MRCOG, 2017
Routine ultrasound in the third trimester cannot reliably predict cord presentation. Cord prolapse can be present when the fetal heart rate pattern is normal but is typically associated with variable decelerations. If cord prolapse is diagnosed at full dilatation, vaginal delivery is possible. An unstable lie is a risk factor for cord prolapse.
Perinatal risk factors and Apgar score ≤ 3 in first minute of life in a referral tertiary obstetric and neonatal hospital
Published in Journal of Obstetrics and Gynaecology, 2020
Maria Cândida Ferrarez Bouzada, Zilma Silveira Nogueira Reis, Natália Fernanda Ferreira Brum, Márcia Gomes Penido Machado, Maria Albertina Santiago Rego, Leni Márcia Anchieta, Roberta Maia de Castro Romanelli
In relation to umbilical cord prolapse, this study pointed out that it is a risk factor for an Apgar score ≤3 in the first minute of life in a univariate analysis. Likewise, the retrospective study by Huang et al. (2012) presented a sample of 40,827 deliveries between 1998 and 2007 with 40 cases of umbilical cord prolapse. A total of 18 (45%) newborns recorded an Apgar score below 7 in the first minute of life and thus required resuscitations, of which 10 maintained an Apgar score below 7 in the fifth minute of life. Umbilical cord prolapse is an obstetric emergency, as it can cause compression of the umbilical cord, compromising the blood supply to the foetus (Goebel et al. 2010).
Comparison of maternal and perinatal morbidity between elective and emergency caesarean section in singleton-term breech presentation
Published in Journal of Obstetrics and Gynaecology, 2020
Sanitra Anuwutnavin, Benjamas Kitnithee, Pharuhas Chanprapaph, Suanya Heamar, Pimnara Rongdech
Concerning risk factors associated with maternal and neonatal complications in EmCS, we found that advanced cervical dilatation (≥7 cm) and deep foetal station (≥+1) had no adverse impact on maternal or neonatal morbidity (Table 5). Unfortunately, data relating to the degree of cervical dilatation and foetal station were missing in 77 (5.8%) and 85 (6.4%) cases, respectively. In contrast, amongst the emergency indications (Table 6), umbilical cord prolapse was significantly associated with increased risk of low 1-min Apgar score (p < .001) and NICU admission (p = .049).
Umbilical Cord Prolapse in the Prehospital Setting: A Case Report
Published in Prehospital Emergency Care, 2022
M. Chatelet, L. Lemoine, P. Balouet, F. Eudier, A. Saleh, T. Delomas, F. Amiot
Umbilical cord prolapse is an obstetric emergency that can be challenging in the prehospital setting. With quick and appropriate management, fetal/neonatal outcomes can be improved. Simulation training of UCP management and maneuvers for emergency clinicians could mean the difference between life and death for this rarely occurring condition (9).