Cord Prolapse policy

[Hushi05]

I didn't mean to hijack adpiRN's post, and I wonder if this got buried. Anyway, I'd really like some feedback if anyone has any to give. Thanks :-)

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]

I answered in the other thread, I'm curious about other hospitals too.

If ruptured and a good strip (with no pitocin running, of course) and a head well applied, I will let her ambulate.

In the case of the PPROM'er, I'd check heart tones first, if the strip the FHR looked fine, then no, I wouldn't do a SVE, in they tones were down... then SVE, push the head up and the call button if I found a cord. And I'd be going for a ride on the bed to the OR.

Hope that helps a bit. I'll check today if we actually have a policy, I don't think so, I think it's a judgement call.

[klone, MSN, RN]

We let our women ambulate freely in labor (unless she has an epidural or is on Mag), regardless of their ROM status.

[MKS8806]

If we have had a reactive strip, we allow labor patients to walk, unless they are blocked or on mag, or unless they have another underlying condition that they physician would rather they not. Usually our doctors will give us orders to let them ambulate for a specific amount of time or get a reactive strip every hour or something.

[bagladyrn, RN]

In answer to your second question: If there is a visble loop of cord at the introitus I place the patient in trendelenberg or knee chest and assess heart tones immediately. If heart tones are good and no decels (pt. not contracting) I do not insert fingers to raise the presenting part. Touching the cord can cause vasospasm and worsen the problem.

I call for help to inform the provider, call OR, prep patient, etc. I remain at the patient's side with a sterile glove on, monitoring heart rate and reassuring/explaining to pt. in case there should be a sudden change in the heat rate that required intervening to lift the presenting part.

If FHT pattern indicated cord compression I would of course insert fingers to keep the presenting part up and procede as above.