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Prolapsed Umbilical Cord

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Amy Walz

on 12 October 2012

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Transcript of Prolapsed Umbilical Cord

Prolapsed Umbilical Cord A Health Concern Presentation by:
Amy Walz "When a portion of the umbilical cord falls in front of, lies beside, or hangs below the fetal presenting part following a rupture of membranes, is defined as a cord prolapse." Definition of Prolapsed Umbilical Cord "Occurs in 0.1% to 0.6% of births."

" Perinatal mortality associated with cord prolapse is at least 10% to 20% and is related to the interval between detection and birth." Anatomy "Occurs in 0.1% to 0.6% of births."

" Perinatal mortality associated with cord prolapse is at least 10% to 20% and is related to the interval between detection and birth. "The umbilical cord consists of an umbilical vein which carries oxygenated blood, and 2 umbilical arteries that return deoxygenated blood... The umbilical vein is thin walled and especially susceptible to compression." Physiology -"The umbilical cord develops from and the yolk sac and allantois (and is therefore derived
from the zygote).

- It forms by the fifth week of fetal development, replacing the yolk sac as the source of nutrients for the fetus.

-The cord is not directly connected to the mother's circulatory system, but instead joins the placenta, which transfers materials to and from the mother's blood without allowing direct mixing.

-The length of the umbilical cord is approximately equal to the crown-rump length of the fetus throughout pregnancy. The umbilical cord in a full term neonate is usually about 50 centimeters (20 in) long and about 2 centimeters (0.75 in) in diameter" Pathophysiology "Cord prolapse may be related to an abnormally long umbilical cord, and is often related to those conditions that result in the fetus not filling the maternal pelvis (eg, mal-presentation such as transverse lie and breech presentation).

Cord prolapse is an obstetric emergency occurring as one of two types:

-Occult or hidden: The cord is alongside the presenting part and is confirmed by palpation on pelvic examination, visualization on speculum examination, or by abnormal or atypical fetal surveillance.

-Overt: The umbilical cord precedes the fetal head or feet and can be seen protruding from the maternal vagina or at the introitus." Risk Factors for Cord Prolapse: -Preterm labour

-Fetal abnormalities

-Premature rupture of the membranes

-Low birth weight

-Obstetric procedures such as cephalic version

-Placenta previa or low lying placenta

-Multiple gestation (with the second born twin having a higher risk)

-Long cord A Nurse's Role in Cord Prolapse Assessment findings may include:

"-Sudden appearance of a loop of umbilical cord at the introitus (opening to the vagina) after rupture of amniotic membranes.

-Complicated variable or prolonged fetal heart decelerations following rupture of amniotic membranes that do not resolve with position change

-Fetal bradycardia in conjunction with rupture of amniotic membranes

-Presence of the umbilical cord in the vagina on vaginal examination

-Any combination of these factors" "-Deficient Knowledge related to the unexpected, emergent nature of care required to ensure maternal and fetal well-being

-Anxiety related to maternal and fetal well-being

-Ineffective Tissue Perfusion* related to cord compression causing decreased placental circulation to the fetus" Epidemiology Possible Nursing Diagnosis's Goals of Treatment: Priorities During Cord Prolapse "-If prolapse occurs when giving care, preparations for prompt cesarean birth should begin immediately. If the maternal cervix is fully dilated, however, a vaginal birth may be attempted."

-The main priority during cord prolapse is to keep pressure off of the umbilical cord until birth

-Determining fetal station and status of the amniotic membranes is important and should be documented for each client

-Regularly observing the perineum should be a part of every woman's assessment, particularly after the rupture of membranes." Nursing Interventions
During a cord prolapse situation, the nurse can assist by: 1) Assist the woman into a knee-chest position using pillows to elevate the buttocks. This position will keep pressure off of the cord until birth.

2) Place a hand into the vagina to elevate the presenting part and separate the cord from the presenting part and pelvis. This will again relieve the pressure on the cord.

3) Continuously assess fetal heart rate. This will ensure that if there is an ominous change, the nurse will be able to see it.

4) Keep the exposed part of the umbilical cord moist and do not reinsert. A vagal response can be stimulated with chilling of the cord.

5) Administer oxygen and IV fluids to ensure enough oxygen is being received by the fetus, as there is pressure on the umbilical cord and therefore a diminished oxygen supply.

6) Provide constant emotional as well as physical support and document all care provided. Evaluation
Desired outcomes include: -Fetal gas exchange is normal, as evidenced by normal fetal heart rate patterns. This includes average variability, no decelerations and baseline within normal limits.

-The client and family verbalize the understanding of the condition and the plan of care.

-the client expresses a decrease in pain and anxiety

-A healthy infant is born References: Evans,.J. & Evans, M. K., (2010). Canadian Maternity, Newborn, & Women's Health Nursing, pp. 643-645.

http://www.sharinginhealth.ca/conditions_and_diseases/cord_prolapse.html

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http://medical-dictionary.thefreedictionary.com/ineffective+tissue+perfusion Umbilical Cord Eventually Replaces Yolk Sac Beginning structure of an umbilical cord Yolk sac Arteries that return deoxygenated blood Umbilical vein which carries oxygenated blood Example of a prolapsed umbilical cord Occult Umbilical Cord Overt Umbilical Cord Risk factors such as prematurity, fetal abnormalities and long umbilical cords can cause the cord to wrap around the baby's neck. *Ineffective Tissue Perfusion is "defined as a state in which an individual has a decrease in oxygen resulting in failure to nourish the tissues at the capillary level." -Fetal gas exchange is normal, as evidenced by fetal heart rate patterns (average variability, no decelerations, and the baseline is within normal limits).

-The client and family verbalize understanding of the condition and plan of care.

-The client expresses a decrease in pain and anxiety

-A healthy infant is born
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