Tuesday, April 16, 2024

MANAGEMENT OF CORD PROLAPSE

Table of Contents

REQUIREMENTS #

  1. Vagina examination tray
  2. Vital signs tray
  3. Resuscitaire
  4. Oxygen apparatus
  5. Face mask/nasal prongs
  6. Big sterile gauze
  7. Jug with warm water
  8. Foetal monitor (manual/electronic)
  9. Surgical gloves
  10. Shaving stick
  11. Intravenous cannula
  12. Intravenous fluids
  13. Giving sets
  14. Gown and head cap
  15. Patient’ s Records
  16. Identification band
  17. Signed consent form
  18. Urethral catheter, urine bag and stopper
  19. Cord clamp/ligature

STEPS #

  1. Establish rapport (refer steps)
  2. Explain procedure to client (refer steps)
  3. Perform hand hygiene and don examination gloves
  4. Administer oxygen by face mask or nasal prongs
  5. Perform hand hygiene and don sterile gloves
  6. Perform vaginal examination to diagnose cord prolapse and determine dilatation of the cervix (and stage/phase of labour)
  7. Check for pulsations in the cord
  8. 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)
  9. 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
  10. Arrange for evacuation and inform doctor if the woman is in first stage of labour and the cord is pulsating
  11. 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
  12. Place the other hand on the abdomen in the suprapubic region to keep the presenting part out of the pelvis
  13. Inflate the bladder with 500 to 700 ml of normal saline once the presenting part is firmly held above the pelvic brim
  14. Adjust maternal position (Knee-chest)
  15. Cover cord with surgical packs soaked in warm saline
  16. Set IV fluids to run slowly
  17. Administer Tocolytics (e.g. Salbutamol 0.5mg IV slowly over 2 minutes to reduce contractions)
  18. Prepare for immediate Caesarean operation
  19. Prepare for delivery or assisted delivery if client is in a second stage of labour and the cord is pulsating
  20. Perform episiotomy if necessary to expedite delivery
  21. Seek obstetrician assistance immediately if breech presentation and the cord is pulsating
  22. Prepare for breech extraction
  23. Assess and resuscitate baby immediately after delivery
  24. Deliver in the manner that is safest for the client if cord is not pulsating
  25. Communicate progress of management to client and family
  26. Maintain Infection, Prevention and Control measures throughout management
  27. Perform hand hygiene
  28. Dispose and decontaminate used items
  29. Record and report all information in the Maternal and Child Health Book (Manual or Electronic)