Escolar Documentos
Profissional Documentos
Cultura Documentos
RCOG, 2008
Aboubakr Elnashar
Prof . Obs Gyn, Benha University Hospital
Aboubakr Elnashar
Cord prolapse:
Definition
Cord presentation:
cord below presenting part with intact membranes
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Incidence
Cord prolapse:
0.1% - 0.6%.
Breech presentation:
1%.
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91/1000.
Prematurity
congenital malformations
birth asphyxia
Asphyxia:
{cord compression and umbilical arterial vasospasm:
preventing venous and arterial blood flow to and from
the fetus}:
hypoxicischaemic encephalopathy and
cerebral palsy.
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Risk factors
General
Multiparity
Low birth weight (<2.5 kg)
Prematurity (<37 w)
Fetal congenital anomalies
Breech presentation
Transverse, oblique and unstable
lie
Polyhydramnios
Low-lying placenta, other
abnormal placentation
Unengaged presenting part
Second twin
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How:
1. Preventing close application of the presenting
part to the lower part of the uterus and/or pelvic
brim.
2. Rupture of membranes
3. Cord abnormalities: true knots or low content of
Whartons jelly: may alter the turgidity of the cord
4. Fetal hypoxiaacidosis may alter the turgidity of
the cord
Induction of labour with prostaglandins is not
associated with cord prolapse.
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3. Avoid ARM if
a. presenting part is mobile.
ARM necessary:
performed with arrangements for immediate CS.
Upward pressure on the presenting part should be
kept to a minimum .
b. cord is felt below the presenting part.
4. CS
When cord presentation in established labour
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No need:
With spontaneous rupture of membranes in the
presence of a normal FHR patterns and the
absence of risk factors for cord prolapse,
liquor is clear.
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pulsating or not?.
If non pulsating:
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Bladder filling
If the decision-to-delivery interval is likely to be
prolonged, particularly if it involves ambulance
transfer
Moderate Trendelenburg position.
By inserting the end of a blood giving set into a
Foleys catheter. The catheter should be clamped
once 500750 ml has been instilled.
Empty the bladder again just before any delivery
attempt, be it vaginal or CS.
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Tocolysis
{reduce contractions and abolish bradycardia}
Terbutaline: 0.25 mg SC
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CS:
Category 1:
Delivering within 30 min or less if there is
suspicious or pathological FHR
but without unduly risking maternal safety.
Verbal consent is satisfactory.
Category 2:
FHR is normal.
The outcome for emergency CS is not worse for
deliveries occurring up to 60 min from decision,
provided that the situation is not immediately lifethreatening for the fetus
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Category 1=Emergency
Immediate threat to the life of a woman or fetus.
Category 2=Urgent
Maternal or fetal compromise but not immediately life
threatening.
Category 3=Scheduled
Needing early delivery but no maternal or fetal
compromise.
Category 4 =Elective
At a time to suit the woman and CS team.
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Regional anaesthesia
may be considered in consultation with an
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Vaginal birth
Most cases operative
Very favourable characteristics:
full cervical dilatation
delivery would be accomplished quickly and safely.
Decision-to-delivery interval: 30 min or less.
Continuous CTG during labour
US: of F heart {audible heart tones and cord
pulsation may cease prior to delivery even though
the f remains alive}
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Breech extraction:
Performed after internal podalic version for the
second twin.
Forceps or ventouse:
Depend on clinical circumstances and level of skill.
No difference in neonatal outcomes for fetal
distress
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Neonatal care
Neonatologist should attend
Paired cord blood samples for pH and base
excess measurement
{strong predictive value of a normal paired cord
blood gas for the exclusion of intrapartum related
hypoxicischemic brain damage}
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,
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Training
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Thanks
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