Table of Contents
REQUIREMENTS #
- Vagina examination tray
- Vital signs tray
- Resuscitaire
- Oxygen apparatus
- Face mask/nasal prongs
- Big sterile gauze
- Jug with warm water
- Foetal monitor (manual/electronic)
- Surgical gloves
- Shaving stick
- Intravenous cannula
- Intravenous fluids
- Giving sets
- Gown and head cap
- Patient’ s Records
- Identification band
- Signed consent form
- Urethral catheter, urine bag and stopper
- Cord clamp/ligature
STEPS #
- Establish rapport (refer steps)
- Explain procedure to client (refer steps)
- Perform hand hygiene and don examination gloves
- Administer oxygen by face mask or nasal prongs
- Perform hand hygiene and don sterile gloves
- Perform vaginal examination to diagnose cord prolapse and determine dilatation of the cervix (and stage/phase of labour)
- Check for pulsations in the cord
- Analyse information gathered from physical examination and the partograph/WHO labour care chart (stage and phase of labour, presentation and position of the foetus, condition of woman and foetus)
- Make a decision about management based on: if the woman is in first or second stage of labour, if the foetus is alive or dead, if the presentation is cephalic or breech
- Arrange for evacuation and inform doctor if the woman is in first stage of labour and the cord is pulsating
- Wear sterile gloves, insert a hand into the vagina and push the presenting part up to decrease pressure on the cord and dislodge the presenting part from the pelvis
- Place the other hand on the abdomen in the suprapubic region to keep the presenting part out of the pelvis
- Inflate the bladder with 500 to 700 ml of normal saline once the presenting part is firmly held above the pelvic brim
- Adjust maternal position (Knee-chest)
- Cover cord with surgical packs soaked in warm saline
- Set IV fluids to run slowly
- Administer Tocolytics (e.g. Salbutamol 0.5mg IV slowly over 2 minutes to reduce contractions)
- Prepare for immediate Caesarean operation
- Prepare for delivery or assisted delivery if client is in a second stage of labour and the cord is pulsating
- Perform episiotomy if necessary to expedite delivery
- Seek obstetrician assistance immediately if breech presentation and the cord is pulsating
- Prepare for breech extraction
- Assess and resuscitate baby immediately after delivery
- Deliver in the manner that is safest for the client if cord is not pulsating
- Communicate progress of management to client and family
- Maintain Infection, Prevention and Control measures throughout management
- Perform hand hygiene
- Dispose and decontaminate used items
- Record and report all information in the Maternal and Child Health Book (Manual or Electronic)
