Heidi Creston, OB RN extraordinaire returns to discuss this obstetrical emergency.
Welcome back, Heidi!
The umbilical cord connects the baby from its umbilicus (belly button) to the placenta (afterbirth) inside the uterus (womb). The cord contains blood vessels, which carry blood, oxygen and nutrients, to the baby and waste products away. After the baby is born, the cord is clamped and cut before delivery of the placenta.
A prolapsed cord is when the umbilical cord slips or falls through the open cervix (entrance of the womb) in front of the baby before the birth. When the cord prolapses, it reduces the amount of blood and oxygen supply to the baby. This causes an emergency situation, which requires immediate delivery of the infant.
A doctor, midwife, or labor nurse will need to insert a hand in your vagina to lift the baby’s head to stop it from squeezing the cord. Alternatively a catheter (tube) may be put into your bladder to fill it up with fluid. This will help to hold the baby’s head away from the cord and reduce pressure on it.
If the provider is able eliminate pressure on the cord through positioning, and the vaginal delivery is imminent, then they may proceed with the vaginal birth. Most providers will perform an emergency Cesarean section.
Patients will be placed in a knee chest position, in order to reduce compression on the cord. The labor nurse will hold the fetus’s presenting part in the vaginal canal, when the physician is ready, the nurse will apply pressure pushing the fetus back up into the uterus. The physician will then remove the infant via Cesarean section.
A prolapsed cord is a desperate situation for the infant requiring everyone to work very quickly.
Prolapsed cords are usually the result of multiple gestations (twins, triplets etc), malpresentation of the fetus (transverse or breech), polyhydramnos (to much fluid around the baby), artificial rupture of membranes (water breaking), or if membranes rupture before head is fully engaged.
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Adelheideh Creston lives in New York. She is former military and married military as well. Her grandmother was a WAVE and inspired her to become a nurse. Heidi spent some time as a certified nursing assistant, then an LPN, working in geriatrics, med surge, psych, telemetry and orthopedics. She’s been an RN several years with a specialty in labor and delivery and neonatology. Her experience has primarily been with military medicine, but she has also worked in the civilian sector.
Heidi is an avid reader. She loves Christian fiction mysteries and suspense. Though, don’t recommend the gory graphic stuff to her… please. She enjoys writing her own stories and is yet unpublished.
An obstetric emergency for sure! As an obstetrician of 17 years, I can't recall a vaginal delivery for a prolapsed cord. We roll the woman's bed back to the operating room, a nurse with her hand in the vagina, keeping the fetal presenting part off the cord. The umbilical cord also spasms as it's exposed to air. Some prolapses are completely unpredicted, but artificially rupturing membranes (breaking the bag with a long crochet looking hook)when the fetal head is not well applied to the cervix (dilating outlet) is a disaster waiting to happen. Thanks, Adelheideh, for a great and informative post.
ReplyDeleteEnjoyed this post! I actually incorporated this scenario into my historical fiction novel. I've always had a secret desire to be a nurse-midwife, so it was as close as I could get!
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