Cord Prolapse

My best answer would be knee chest position. Your priority is to relieve pressure on the cord and re-establish blood flow to the fetus. This would be best accomplished by placing the mom in knee-chest position. Reverse Trendelenburg position might also be of some help, but less so, I think. Wrapping the cord in sterile gauze is of no use, as the vagina is not a sterile environment, and since membranes are ruptured, there is already the possibility that bacteria and other micro-organisms have begun to ascend the reproductive tract.

If the cord is trapped inside the vagina, I believe you would insert a sterile gloved hand to put counter-pressure against the fetal presenting part, in an effort to "lift" it off the cord, again relieving pressure on the cord and re-establishing blood flow to the baby.

This is a true emergency requiring a team effort. Help is needed in the room immediately to provide O2 and IV fluids to mom, call for medical help, and prepare for a C-section.

To add to your question about cord prolapse,
I was just studying for a perinatal core class. You do want to wrap the cord with gauze and saline to prevent the cord from spasming. This will also help optimize fetal oxygenation.
Hope that helps

For regards to the cord hanging out of the vagina I was always told to try and AVOID touching the cord as that could lead to vasospasm and cause worsening complications, and use a gloved hand to help hold the head off the cervix w/ the pt either in trendelenberg or hand/knee position. The gloved hand should stay put holding the had until delivery is accomplished via a c/s.
Absolutely right in that you need many hands in the room to carry this out expediantly. I haven't thankfully had it happen this severly but have had a prolapse into the vagina and that is what you do call for help, get the head off the cervix, position, O2, IVF and anesthesia, run don't walk to the OR...this is a true crash, esp. when the fetus doesn't respond to interventions.

As for the second question. From my understanding it takes 4-6 wks for involution to occur and the cervix to heal from delivery, not to mention the epis and maternal discomfort. I believe this is why they suggest following up w/ you healthcare provider so that a speculum and pap can be done to assure proper healing.

My twenty-two cents

Sorry, Shanie. I had a brain craamp and gave you the wrong info about Trendelenburg position. I had it backwards. Trendelenburg position has the patient positioned at roughly a 45 degree angle with the head down, which would be an appropriate intervention, but probably still less effective than knee-chest, unless the patient had an epidural and simply couldn't be placed in the knee-chest position. Obviously, once in the OR, knee chest would no longer be appropriate either, and Trendelenburg would be the position used while prepping the patient (very quickly) for a section.

Besides all the above mentioned interventions one of our docs has had us place a foley catheter in and fill the bladder this also aids in lifting the presenting part and holding it off the cord. This is done by one person while someone else is in the bed holding presenting part up with sterile glove and then we all run to the section room with the person in the bed getting a free ride.

Hi Shanie,

I just covered Postpartal care in Maternity class this week.

We learned that sex may resume about 2 weeks post birth and once the Lochia Serous (serous, pink/brown discharge) is gone and she has Lochia Alba (whitish discharge).

In repsonce to Imastork...

I have had a midwife suggest this as well, but the House OB refussed to do it stating that a full bladder can cause problems of its own, not to mention that it wastes time, just a gloved hand and repositioning are needed along w/ a quick ride to the OR.

Curious to know if it has worked for you???