Umbilical Cord Prolapse

Diagnosis

  • Use a fetal heart monitor to measure the baby’s heart rate. If the umbilical cord has prolapsed, the baby may have bradycardia (a heart rate of less than 120 beats per minute).
  • Conduct a pelvic examination and may see the prolapsed cord, or palpate (feel) the cord with the fingers.

Management

  • Assess a laboring client often if the fetus is preterm or small for gestational age, if the fetal presenting part is not engaged, and if the membranes are ruptured.
  • Periodically evaluate FHR, especially after rupture of membranes (spontaneous or surgical), and again in 5 to 10 minutes.
  • If cord prolapsed is identified, notify the physician and prepare for emergency cesarean birth.
  • Assess cord pulsations constantly.
  • PRIORITY: To relieve pressure on the cord to improve blood flow through it until delivery. This is done by any of the following ways:
  1. Placing a sterile gloved hand in the vagina and manually elevating the fetal head off the cord. This position is maintained until the physician orders it to stop which is usually before cesarean delivery.
  2. Placing the woman in a knee-chest or Trendelenburg position. These positions cause the fetal head to fall back from the cord.
  3. Elevate the hips of the woman with pillows and side-lying position maintained.
  • To confirm the presence of fetal heart activity before cesarean delivery, ultrasound examination may be used.
  • Administer oxygen at 10 LPM by face mask to the mother to improve oxygenation to the fetus.
  • A tocolytic agent such as terbutaline may be prescribed to reduce uterine activity and pressure on the fetus. Terbutaline inhibits contractions, increasing placental blood flow and reducing intermittent pressure of the fetus against the pelvis and cord.
  • Birth is always cesarean section unless vaginal delivery can be accomplished more quickly and less traumatically.
  • Warm, saline-moistened towels retard cooling and drying of the cord. If the cord has prolapsed to the extent that it is exposed to room air, drying will begin which leads to atrophy of the umbilical vessels.
  • If the cord is protruding from the vagina, no attempt should be made to replace it because doing so could traumatize and further reduce blood flow through the cord. Cord manipulation can induce umbilical artery spasm, which would reduce blood flow between the fetus and placenta.
  • In cases where the cervix is fully dilated at the time of prolapsed, the physician may choose to deliver the infant quickly, possibly with forceps, to prevent fetal anoxia.
  • If dilatation is incomplete, the birth method of choice is upward pressure on the presenting part, applied by the practitioner’s hand in the woman’s vagina to keep the pressure off the cord until the baby can be born be cesarean birth.
  • The nurse must also consider the woman’s anxiety.
  • Explanations must be made simple because anxiety interferes with the woman’s ability to comprehend them.

image courtesy of mahalo.com

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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