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Umbilical Cord Prolapse

Umbilical Cord Prolapse. Risk Factors Malpresentation, prematurity, polyhydramnios, high presenting part, long cord Epidemiology. Rapid Response to Prolapse. Recognize non-reassuring tracing Visually inspect/palpate cord to diagnose Assess fetal status (FHTs, ultrasound)

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Umbilical Cord Prolapse

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  1. Umbilical Cord Prolapse • Risk Factors • Malpresentation, prematurity, polyhydramnios, high presenting part, long cord • Epidemiology

  2. Rapid Response to Prolapse • Recognize non-reassuring tracing • Visually inspect/palpate cord to diagnose • Assess fetal status (FHTs, ultrasound) • Assess labour progress (dilation, station) • Do not attempt to replace cord • Hold presenting part off cord • Foley catheter • Position change (Trendelenburg, Knee-chest) • Tocolysis

  3. Prevention of Prolapse • Identify risk factors • Malpresentation, high presentation • Patient education re: membrane rupture at home • No AROM when station high • May “needle” membranes under double set-up

  4. Multiple Gestation • Occurs in 1.5% of U.S. births • 2-5 X higher perinatal morality • Maternal complications common • HTN, anaemia, hyperemesis, abruption, praevia, PPH, operative delivery • Dizygosity (fraternal) = 2/3 • Increases with age, parity, familial factors • Monozygosity (identical) = 1/3

  5. Diagnosis of Multiple Gestation • Ovulation induction • Family history • Hyperemesis • Uterine size > dates • Early PIH • Elevated MSAFP • Auscultation of > 1 fetal heart beat • Polyhydramnios

  6. Associated Complications • Prematurity • Congenital anomalies • Pregnancy-induced hypertension • Placenta praevia • Fetal death: 0.5% - 6.8%

  7. Delivering Twin B • Attempt internal podalic version • Breech delivery is reasonable choice when: • External version unsuccessful or not attempted • Strong labour and Baby B deep in pelvis • Cord prolapse or nonreassuring FHR tracing

  8. Summary • Six types of malpresentations • Diagnosis by physical exam and imaging • Be alert to etiologic association • Be alert to potential complications • Vaginal delivery may be considered for OP, breech, face and compound presentation

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