Umbilical cord prolapse! скачать в хорошем качестве

Umbilical cord prolapse!

From UpToDate: ●Fetal and maternal factors that have been associated with cord prolapse include: ●Malpresentation (breech, transverse, oblique, or unstable lie) ●Unengaged presenting part ●Polyhydramnios ●Preterm gestational age ●Low birth weight ●Second twin ●Low lying placentation ●Pelvic deformities ●Uterine malformations/tumors ●External fetal anomalies ●Multiparity ●Long umbilical cord ●Prolonged labor ●Atypical placental cord insertions (velamentous and marginal) Obstetric interventions are associated with those that may elevate the fetal head out of the pelvis and include: ●Iatrogenic rupture of membranes,especially with an unengaged presenting part ●Manual rotation of the fetal head ●Amnioinfusion ●External cephalic version ●Internal podalic version ●Application of forceps or vacuum ●Clinical presentation – The first sign of cord prolapse is usually severe, prolonged fetal bradycardia or moderate to severe variable decelerations or late decelerations after a previously normal tracing. The prolapse may be overt or nonovert (occult). ●Management – Standard obstetric management of cord prolapse is prompt cesarean birth to avoid fetal compromise or death from compression of the cord. ●Intrauterine resuscitation – Intrauterine resuscitation using maneuvers to elevate the presenting part (eg, manually, or placing the patient in a knee-chest position or deep Trendelenburg, or retrofilling the bladder with at least 500 mL of saline) and administering a tocolytic may reduce pressure on the cord while preparations are being made for delivery. ●Outcome – Reported perinatal mortality related to cord prolapse varies widely, from 0 to 3 percent for events occurring among patients monitored on a labor and delivery unit. Asphyxia and complications related to prematurity and congenital anomalies are the major causes of poor outcome. The degree of cord compression, the interval between cord prolapse and delivery, and successful use of intrauterine resuscitation maneuvers all impact the risk of asphyxia. #cordprolapse #umbilicalcordprolapse #birth #childbirth #laboranddelivery