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A clinical practice guideline for the management of umbilical cord prolapse in obstetrics. It covers the background information, definitions, key points, and procedures for managing cord prolapse in hospital and community settings. The guideline also includes references and keywords.
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Background information .......................................................................................... 3 Definitions^5 .............................................................................................................. 3
Key points ............................................................................................................... 4 Management of cord prolapse ................................................................................ 4
Management ........................................................................................................... 8
This document should be read in conjunction with this Disclaimer
Cord prolapse quick reference guide (>23 weeks)
Dial 55 - ask for appropriate Code blue- Caesarean or medical as required Call 000 if in the Community (CMP)
Consider filling the bladder with 500 mL of Normal Saline 0.9% if delay to theatre is expected
If the woman is fully dilated consider operative delivery
Consider Terbutaline 250 MICROGRAMS subcutaneous
Turn off Syntocinon
Cord prolapse in hospital / Family Birth Centre
1 Call for assistance^6 Press the emergency assist bell. Dial 55, call a CODE BLUE MEDICAL as required If the fetus is potentially viable, call a Code Blue – Caesarean Section. The type of code depends on the gestation.
Management for cord prolapse is as follows: Less than 23 weeks gestation: The gestation is below viability – do NOT call an emergency code. Notify the obstetric medical team. Unless a previous management plan has been confirmed by the obstetric team transfer the woman to the Labour and Birth Suite for ongoing care.
23 to 25 weeks gestation: Dial 55, CODE BLUE MEDICAL should be called. This allows medical and midwifery staff to assess the situation on the ward and make a management decision in consultation with the parents. A decision is made by senior medical staff if a caesarean section is to be performed.^6 If the decision is made for a Caesarean Section birth, then dial 55, call a Code Blue – Caesarean Section.
Equal to or more than 25 weeks gestation: Dial 55, CODE BLUE - CAESAREAN SECTION should be called. This informs the anaesthetic, obstetric, paediatric, and Labour and Birth Suite staff to go immediately to theatre rather than the ward. Prepare and take the woman to theatre.^6 Verbal consent is appropriate in this situation.^6
2 Note the time the code is called
3 Position the woman
Place the woman into the exaggerated Sims position.^6
The woman lies on her left side in a semi-prone position, with her right knee and thigh drawn up: her left arm lies along her back while the hips and buttocks are elevated on a wedge or pillow. This relieves pressure on the umbilical cord.^5
5 Fetal assessment
Auscultate the fetal heart rate as soon as possible.
Continuous fetal heart rate monitoring should be initiated to allow constant assessment of fetal well-being. An ultrasound should be done immediately if: No cord pulsation can be felt Fetal heart rate cannot be found on auscultation.
6 Intravenous therapy (IVT)
If intrapartum, cease Syntocinon infusion immediately
Ceasing oxytocin may decrease contractions which cause pressure on the cord.^5 Insert intravenous cannula – commence Compound Sodium Lactate Solution intravenously.
7 Administering Terbutaline
Consider administration of Terbutaline 250 micrograms subcutaneously for women in established labour.
Tocolysis may be advocated to inhibit uterine activity.^6 Contractions can exacerbate cord compression.^1
8 Urinary catheterisation
Consider catheterisation of the bladder if delay to theatre is expected: Attach a standard infusion set to a 16 g indwelling catheter Instil a Sodium Chloride 0.9% infusion into the catheter until the distended bladder is visible above the symphysis pubis Clamp the catheter and attach to a drainage bag Remove the clamp and allow urine to drain when the time is appropriate in theatre
A full bladder can inhibit uterine activity and reduce compression on the cord by raising the presenting part.^1
500 – 700 mL of solution (warmed or at room temperature) is generally enough to fill an empty bladder.^5 Caution is advised if the woman has not recently voided.
The infusion clamp should be removed and the bladder emptied just before entering the peritoneal cavity during caesarean section.^4
9 Documentation Detailed notes of the incident should be documented in the medical record. 10 Support and Debriefing Explanation of the management should be given to the woman and support people during the incident as appropriate.
Follow up discussion after the birth by medical and midwifery staff is essential to reduce adverse psychological outcomes.^5
Cord prolapse in the community (Community Midwifery
Program)