knee-chest

M waitng 2, NE1?

I really should know this, but luckily I have never had a patient with a cord prolapse. When they tell you to put pt. in knee-chest, do they mean like a McRobert's maneuver where the pt. is on their back and the knees are flexed up on the abdomen, or is the pt. suppossed to get in a modified hands-knees position. (I always thought that one would be kind of hard to get them to do when you have your hand up there.) Thanks!

The patient needs to be in a true knee-chest position, with her chest down at the level of the bed and her hips up in the air, so that gravity will allow the baby's head (or presenting part) to "drop away" from the cervix and relieve pressure on the cord.

At our facility we handle cord prolapses by pushing what ever part of the baby is putting presure on the cord up and staying in that position until the baby is out by c-section...that means being under the drape in the OR!! It is a true emergency!!

I've seen pts put into trendelenburg instead of knee-chest. that would seem a little quicker and simpler I suppose.

I guess if you had to wait any amount of time(for anesthesia, MD etc..) then knee- chest would work while you keep your hand holding the presenting part off the cord. Otherwise, move her quickly to an OR table.

Also, dont' forget, inserting and backfilling a foley catheter can be very useful, as well, if you know the csection won't be within the next 5 minutes....this is a time when you need a TEAM working the case, and where each nurse KNOWS his or her role and how to play it......

one holding presenting part off of cord....

another getting IV and foley cath and/or prepping pt for surgery

and yet another communicating with MD, House supervisor, peds, etc, and getting appropriate personnel in to handle this emergency.

This is why I think drills are so valuable.

Knee chest is the best position, but not always possible if the pt. has a dense epidural. In that case trendelenberg works.

I really should know this, but luckily I have never had a patient with a cord prolapse. When they tell you to put pt. in knee-chest, do they mean like a McRobert's maneuver where the pt. is on their back and the knees are flexed up on the abdomen, or is the pt. suppossed to get in a modified hands-knees position. (I always thought that one would be kind of hard to get them to do when you have your hand up there.) Thanks!

It means patient is on hands and knees, with knees apart, butt up in the air and chest down low.