Umbilical cord prolapse: Difference between revisions
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*Emergent OB/Gyn consult | *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> | *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 | **Examiner who diagnosed umbilical cord prolapse must maintain umbilical decompression until patient is in OR | ||
*Place | *Place patient in knee-chest position and encourage not to push or cough<ref name="Mercado" /> | ||
==Disposition== | ==Disposition== | ||
Revision as of 18:56, 1 July 2016
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 patient is in OR
- Place patient in knee-chest position and encourage not to push or cough[1]
Disposition
- Admit to L&D