Umbilical cord prolapse: Difference between revisions
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==Background== | ==Background== | ||
*Occurs in 0.5% of pregnancies | |||
*Likely secondary to the presenting fetal part not filling enough of the lower uterus and allowing cord to present first during labor.<ref name="Mercado">Mercado J, Brea I, Mendez B, et al. Critical obstetric and gynecologic procedures in the emergency department. Emerg Med Clin North Am. 2013 Feb;31(1):207-36.</ref> | |||
*Risk factors<ref name="Mercado" /> | |||
**Low birth weight | |||
**Multiparity | |||
**Fetal malpresentation | |||
==Clinical Features== | ==Clinical Features== | ||
*Presentation of ubmilical cord before fetal delivery (can be felt as pulsatile structure on exam) | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
*Clinical diagnosis | |||
==Management== | ==Management== | ||
*Do NOT attempt to reduce instead, elevate the presenting fetal part to reduce compression and transport to OR<ref>Holbrook BD. Umbilical cord prolapse. Obstet Gynecol Clin North Am. 2013 Mar;40(1):1-14.</ref> | *Emergent OB/Gyn consult | ||
*Do NOT attempt to reduce cord - instead, elevate the presenting fetal part to reduce compression and transport to OR for emergent C-section<ref>Holbrook BD. Umbilical cord prolapse. Obstet Gynecol Clin North Am. 2013 Mar;40(1):1-14.</ref> | |||
**Examiner who diagnosed umbilical cord prolapse must maintain umbilical decompression until pt is in OR | |||
*Place pt in knee-chest position and encourage not to push or cough<ref name="Mercado" /> | |||
==Disposition== | ==Disposition== | ||
*Admit to L&D | |||
==See Also== | ==See Also== | ||
Revision as of 10:05, 3 August 2015
Background
- Occurs in 0.5% of pregnancies
- Likely secondary to the presenting fetal part not filling enough of the lower uterus and allowing cord to present first during labor.[1]
- Risk factors[1]
- Low birth weight
- Multiparity
- Fetal malpresentation
Clinical Features
- Presentation of ubmilical cord before fetal delivery (can be felt as pulsatile structure on exam)
Differential Diagnosis
- Emergent delivery
- Umbilical cord prolapse
- Breech delivery
- Shoulder dystocia
- Perimortem cesarean delivery
Diagnosis
- Clinical diagnosis
Management
- Emergent OB/Gyn consult
- Do NOT attempt to reduce cord - instead, elevate the presenting fetal part to reduce compression and transport to OR for emergent C-section[2]
- Examiner who diagnosed umbilical cord prolapse must maintain umbilical decompression until pt is in OR
- Place pt in knee-chest position and encourage not to push or cough[1]
Disposition
- Admit to L&D