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 lady parts 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 lady parts, 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 Jolie : thank you very much, I have anothe question - regarding resumption of sex activity after birth:

1. after 1st postnathal check up (6 weeks)

2. as soon as epysiothomy is healed and lochia are gone

3. when the couple is ready

4. by the 1st check up and with whitish secretions

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 lady parts 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 lady parts 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???

Originally posted by Shanie

Hi everybody,

I am currently preparing to CRNE and I've got a question regarding priorities in care of cord prolapse.

1. If cord is outside lady parts what you will do first:

a. put woman in Trendelenburg

b. knee chest position

c. wrap the cord with sterile gause

If cord is trapped inside the lady parts what is your nursing priorities.

I can't find the precise answer, please help me to decide.

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.