Daily Bolus of LR: Umbilical Cord Prolapse

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November 16, 2011 by dailybolusoflr

Umbilical Cord Prolapse

· Is an uncommon obstetrical emergency

· The umbilical cord presents either alongside or beyond the presenting fetal part

o This can occur in patients whose membranes are not ruptured, but in most instances, these patients will be evaluated on L&D

· Can result in lack of oxygen to the fetus as the cord can be compressed between the fetal presenting part and the uterus, cervix or pelvis

o This often is noted with significant and prolonged fetal bradycardia or deceleration, in particular with contractions

· Higher risk for occurrence with breech presentations, prematurity, multiple gestations and polyhydramnios

· If the fetal presenting part is present in the vagina, the provider should insert their hand and elevate the fetal part off of the cord

· The next most important management step is getting the patient to a provider who can perform a stat C-section

· Additional maneuvers such as use of trendelenburg position or knee-chest position can offer some assistance as well in alleviating some of the cord compression

· Lastly, if imminent OB assistance is not available, tocolytics can be given to decrease the strength of contractions and provide decreased pressure on the umbilical cord

Ref: Roberts and Hedges

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