Cord Prolapse

Throw out the sterile gauze completely they are just trying to trick you with that one. Sterile wet gauze is for intestines outside the cavity. The other two kind of go hand and hand and a little more difficult to choice either could be right so I would have to use theory and critical thinking to choice. I would first go with the knee chest position this is going to help open the cervix more and hopefully relieve pressure on the cord, but I would move rapidly into Trendelenburg if there isn’t an almost instant change in the viable decelerations caused by the prolapsed cord. Trendelenburg is used because it gravity should force the baby back into the uterus a little and off the cervix. Also with your third or fourth hand support the body systems with additional O2 per mask at 8-10 liters I would only pick knee chest first because you are trying to deliver a baby so you don’t want to help the baby back into uterus per say or have the part of mom you’re working on facing the ceiling. Prepare for a cesarean, although it’s not always necessary if changing position of mom works well.

Sexual activity postpartum can take place after the healing of the perineum and uterus has taken place traditional that was 6 weeks. But, healing actually occurs in 2-4 weeks. So basically after 2-4 weeks and the desire and comfort dictate - tear it up!

I prolapsed my cord at home! Labor for me is not as bad as my severe menstrual cramps. You have a few minutes in-between without any pain so I thought it was easier than cramps. I was about to go to the hospital when I felt the cord prolapse. I called my husband, lay down on the floor and raised my hips to try and put myself in trendelenburg. I then put my hand on the presenting part and gently pushed up. I had my husband call for an ambulance but then after a couple minutes decided we would be better off to just go to the hospital. I happened to train at the hospital we were going to and remembered the telephone number for L&D. I had him tell them to set up for a STAT C/S and because the cord was in my hand and I could see the wall clock that the FHT was at 126. We went out in our nightgown/nightshirt into a snowy winter night – I still remember our footprints in the snow. I got into the backseat of the car and resumed my position. Two minutes later we were at the hospital and the staff was outside waiting. I stood up and the cord now dropped to my knees (I guess trendelenburg works!) They popped me up on the stretcher and the resident put her gloved hand in on the baby’s head. I then went through the ER stark raving nude from the waist down, legs spread, with the residents hand in place and at the time I didn’t even care. The elevator was being held for us and up we went to the Del. Rm. Onto the OR table and ultrasound showed a FHT of 110. Here is where I lost it as I was so afraid of general anesthesia. The residents went to scrub and the nurses frantically called the anesthesiologist as he was attending a cardiac arrest. My OB’s partner on call happened to sleep at the hospital due to the snow. He hit the room with the anesthesiologist and said "Give a me bottle of betadine and a scalpel." He looked at me freaking out and said “Do you want a dead baby? Well shut up and let them put you to sleep” He C/S'ed me still in my night gown, no gloves, while the residents scrubbed. My son was breathing on his own with a 9 apgar at 5 minutes. Total time between prolapse at home and delivery = 16 minutes. My scheduled lay midwife, who was to be my birthing coach, only, arrived at this point. It was then assumed that I was a screwed up home delivery and I was treated as a monster from then on in by the staff even though she had coached me through my totally natural, stood for the delivery, nursed on the table, identical twin delivery, 16 months earlier. One nurse finally told me that I did a great job and I was the only live prolapsed at home birth she had seen in 14 years of work. So, glad I paid attention in my diploma RN school’s OB rotation! My son is as normal as can be and routinely is at the top of his class in school.

The only one I have ever seen we put pt in knee chest to del rm. with sterile gloved hand holding presenting part off cord, we sort of threw some betadine somewhere near the abd. none of us even washed our hands let alone scrubbed, we did have gowns and gloves, and mom was given a healthy dose of abx on table. Oh and the res cut the babes head on the way in, did I mention that by a VERY unlucky set of circumstances the sterile hand was our attending, mom just happened to rupture just as he walked in the rm to check her. NOT an experience I would like to repeat, was at a hosp where LR were seperate from DR and from SROM in LR to birth in DR took a whooping total of 7 minutes and baby had PERFECT cord gases, but required 4 (if i remember right) sutures to the scalp.

We had a prolapsed cord recenly in APU. She was up to the RR and called out. Very much cord was hanging out. We put her in knee/chest, I inserted my (sterile gloved) hand to lift and protect the cord and we ran to the OR. I could count the fetal rate by feeling the cord pulsing in my palm. There were about 5 nurses present- one for the pt/cord and 4 to push the bed. Someone else called ahead to let them know we were in route. Good outcome, too.

The only thing I would do differently is put her on her back because of the contortions needed to get her in position on the OR table.