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Cord prolapse for undergraduate

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Undergraduate course lectuers in Obstetrics &Gynecology Prepared by DR Manal Behery,Faculty of medicine,Zagazig University – PowerPoint PPT presentation

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Title: Cord prolapse for undergraduate


1

CORD PROLPSE
DR MANAL BEHERY Assistant Professor, Faculty of
Medicine, Zagazig University
2
Definition
  • Cord Presentation Cord in front of presenting
    part before the rupture of membranes
  • Cord Prolapse Cord in front of
  • presenting part after rupture of
  • membranes

3
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4
Cord presentation vs. Cord prolapse
5
Occult cord prolapse
  • Cord lying alongside the presenting part
  • Occult vs. presentation vs. prolapsed cord

6
Incidence
  • Primigravida 0.45
  • Multigravida 0.66 (Risk ratio 23)
  • Cephalic 0.3
  • Frank breech 0.9
  • Complete breech 5
  • Footling 10
  • Shoulder 15
  • Contracted pelvis 4-6 times

7
Causes
  • Malpresentation - face, brow, breech and shoulder
  • Prematurity
  • Polyhydramnios
  • Multiple pregnancy
  • Long cord (90-100 cm)
  • PROM
  • CPD
  • Obstetric interventions - Amniotomy, Intrauterine
    pressure catheter, scalp electrode, external
    cephalic version,

8
Dangers
  • Mortality rate as high as 50
  • Hypoxia
  • Spasm of vessels
  • Operative trauma to suboxgenated fetus

9
Diagnosis
  • Cord pulsations
  • CTG shows
  • variable decelerations
  • Fundal pressure
  • causes bradycardia
  • Meconium stained
  • liquor

10
US cord loops Cord outside vulva
11
Prevention
  • Do US for malpresentation and cord presentation
  • 2.FHR monitoring
  • 3.Avoid ARM in an unengaged head
  • 4.PV exam after ROM

12
Management
  • Lift presenting part off the cord
  • Instruct patient NOT to push
  • Position
  • 1. Knee chest
  • 2. Trendelenburg
  • 3.Exaggerated position

13
Knee chest position
14
Trendelenburg position
15
Exaggerated sims position
16
Management (cont..)
  • Vulval pad
  • Replacement of cord
  • Tocolysis (ritodrine)
  • Funic Reduction
  • Manual replacement of cord into uterus
  • Cord gently pushed above presenting part while
    other cord decompression techniques are applied

17
Stage II Labor
  • - Expedite delivery with episiotomy and vacuum
    extraction or forceps
  • Prepare for resuscitation of the newborn.

18
Fetal Mortality
Fetal Mortality
  • Overall - 50
  • 1st stage of labour - 70
  • 2nd stage of labour -30
  • Neonatal death - 4
  • Perinatal mortality- 20

19
Fetal Mortality
Prognosis
  • More with vertex than breech
  • More with anterior than posterior.
  • More in prime than multi
  • lt 5 minutes, prognosis good, gt 5 mins, damage and
    death.

20
THANK YOU
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