2nd prolapsed cord in the past few months!

[adpiRN]

Am I cursed?! I thought this was supposed to be a rare event?!

It really angers me b/c both were very preventable and caused by AROM too early when the baby was still high.

The one today frustrated me b/c I asked twice for the OB to delay AROM, more out of patient comfort (since it was before she was comfortable with her epidural) but fear of a prolapsed cord is always in the back of my mind with AROM. It makes me nervous.

And most of the time it's just unneccesary!

The OB was giving me attitude for making the suggestion to delay AROM in front of the patient. I think she felt it undermined her in front of the patient.

Anyway, she finally AROMed her after she got comfortable.

It made me a little nervous that as she was doing it she mentioned how high the baby was and asked me to apply fundal pressure to keep the head applied. Hmmmm.

Anyway, the patient remained mostly upright for a few hours. I started to see more and more little variables on the tracing so I went in to see if would be better if I turned her on her side. Variables got much deeper and longer. Moved her to the other side. Same thing.

OB came to room, did exam, 6 cm and.... low and behold and prolapsed cord! Stat c/s, beautiful baby, apgars 9/10.

I guess all turned out well in the end.

Maybe this would have happened anyway. I heard her cord was very long and she was s/p version a few weeks before, so there could have already been issues with the cord position.

Thank god it didn't happen at home!! We've had that before and it did NOT end well.

But there's also the chance that if she hadn't AROMed her she could have delivered lady partslly with no issues. Who knows....

[Elvish, BSN, DNP, RN, NP]

This is exactly why I didn't let the doc AROM me at 3.5cm when I got to the hospital with my daughter a couple months ago. (I thought I was further along than I actually was but that's another story.) My daughter was still high up and I thought, Hell no, you are not going to break my bag and prolapse my cord. I don't think he was happy about my refusal but I didn't care, and fortunately my nurse was a great advocate. I didn't SROM until 9cm.

I had a pt on postpsrtum a couple years ago, grand multip on her 8th or 9th baby, all previous SVDs, who had to be sectioned because some resident wanted practice with the amnihook and her cord prolapsed. She (the pt) was cheesed off....and I would have been too. Who knows what would've happened if they'd left well enough alone on someone whose body has clearly proven that it knows what to do.

All that to say...I feel your pain. It is so frustrating when things are done for convenience and not for true pt benefit.

[feisty]

This has only happened to one of my patients. It was SROM and I still remember looking at the monitor and watching the baby's heart rate actively decel for just a moment before springing into action. The other thing I remember is the look on the couples face as she is being wisked off to the OR.

I am always concerned when the MD's AROM someone whose fetus is still high. I stand by with my gloves on just in case. Very frustrating to say the least.

[mkjh]

Sucks for the pt to go through a version and still end up with a c/s b/c the doc insisted on doing the AROM. If I was the pt and really knew what had happend, I'd be ******.

(I didn't SROM until 10cm)

[adpiRN]

I also heard that the OB was saying to other people "well I didn't cause the prolapsed cord!" I guess her justification is that it happened hours after actual AROM??

I wonder if in her head she thinks it's MY fault for repositioning the patient.

I didn't even talk to her after the surgery because I was ****** at her.

I didn't feel like listening to her rambling on about how it's not her fault...

What does she think causes a prolapsed cord?!?!

[WindyhillBSN]

What a nightmare! I was 5cm when my membranes were ruptured...but it turned out good b/c my little one had meconium...thank God he didn't swallow any. I wonder how long he was in there like that?

[klone, MSN, RN]

What a nightmare! I was 5cm when my membranes were ruptured...but it turned out good b/c my little one had meconium...thank God he didn't swallow any. I wonder how long he was in there like that?

I'm sure he did swallow some.

[Hushi05]

I have two questions on related issues:

Where I work, residents generally don't want a patient with ROM to get up and walk, use the bathroom, etc. Sometimes if we push, they'll say, "Oh, well, ok since the head is applied." Some of the midwives are more lenient ("She walked in her ruptured."). Many of the nurses will not let a woman who comes into triage c/o ROM get up again once she is in the bed and ROM is confirmed. "Help me wheel her to her room."

Anyway, I'm not sure what is reasonable or not. What is the policy where you work? If there is no policy, what do your providers say? What do you do in your own practice?

***

Second question, I've never personally dealt with a prolapsed cord. Obviously, if the patient is *in labor* and you see decels, you have to get your hand in there and keep the babies head up. But it has happened on our antepartum unit that a PPROMer who is not in labor will prolapse a cord. (the nurse notices during assessment or the patient feels something). One of our OBs was scolding the nurse for putting her hand in the patient to raise the head and said that since the patient wasn't in labor, there was nothing pressing on the cord. She also said something about if the fetal heart beat goes chugging along without any decels, there is no need to put your hand in. (I don't believe in this case that the patient was on a monitor- should the nurse have gone to get one to assess the FHR?)

So, what would you have done? Assess the heart rate first? Put your hand in? Just call the physicians and prep for a c/s without putting your hand in?

[AprilAZRN]

if head is well applied and FHT is reassuring for an hour or so I'd let the SROM'd pt w/ no other risk factors ambulate.

The PPROM'er, I'd have gotten heart tones first. You really want to minimize SVE's.