prolapsed cord

[magz53]

I lost years off my life recently with a prolapsed cord. I am so angry that the medwife ruptured a G7 just to "get her delivered". Actually the term I received on report from the L + D nurse was "finish her off". The patient was getting uncomfortable and given her gravida, I felt I should check her which would have been more than 2 hours after the AROM. My check revealed a posterior cervix, head not applied to the cervix and a stretchy 4 cm., about -2. What on earth was she when the MEDwife ruptured her ?? 2 minutes after my shift started, she began variable decels........oh I forgot to say, she was also on Pit. The decels got longer and deeper at which time I called the MEDwife in to report what I was seeing. The response ??? " Oh yee of little faith ". The baby descended somewhat rapidly and what did we see ?? Not caput, but a shiny bright cord !!!! OK, pit off, trendelenberg, O2, IV open, pillow under hips and MEDwife on bed trying to get head off cord and off we go to the OR. Luckily the OR staff had not left the building. It seemed like an hour, but the babe was actually out 12 minutes from when we left the room.......and luckily OK. We were lucky that it was change of shift and we had help. Had it happened later in the shift, we would not have been so lucky. I don't believe the cord would have preceded the head if the vertex was well engaged in the pelvis and the head well applied to the cervix. I am soooooooooooooooooo sick of all this needless intervention to manipulate time schedules. The women go along with it, in fact sometimes demand it. When we nurses express concern, we are being told to be thankful we have a job. How is that for not addressing legitimate concerns ?? Anyone else have an experience with cord prolapse ?

[lamazeteacher]

I'm confused about your account above. Here are a few of my concerns:

What did you mean when you wrote "the patient was getting uncomfortable and given her gravida"?

When you checked her, didn't you feel the cord?

Midwives don't usually give pit without an OB in attendance, where was he or she?

I've been on duty when a patient had a prolapsed umbilical cord, and she was immediately taken to the OR for a c/s. Were her baby's decels during or after contractions?

[Elvish, BSN, DNP, RN, NP]

The patient was getting uncomfortable = increased pain from contractions? More frequent contractions? Stronger ones than before as happens with AROM?

Given the gravida - on a G7 after AROM, think she might be prone to delivering pretty quickly afterward.

Babe's head was not on the cervix, as magz wrote, he was -2. Plenty of wiggle room for a cord to not be felt.

I hate situations like this, when it is obviously so unnecessary that mom needs intervention and they're thrown at her anyway. Both mom and baby can be affected.

I was in the nursery a couple years ago when a 3/2 came in at 37+3 contracting nicely q 3-4 minutes and about 3cm along. Instead of letting her just do her thing, which she has proven that she can do, the resident decided that she needed Pit & AROM. So instead of a nice baby that has had time to ease her way into the world and be happy about it, I get a shell-shocked 37 weeker that is grunting and retracting like a turkey, and about the color of a blueberry. She came around eventually, but it was so unnecessary, the whole thing.

[htrn]

Medical management has it's place - why can't everyone remember what that place it?!?!?!?

[magz53]

I came on duty 2 hours after AROM. Given the fact she was gravida 7 and ruptured for 2 hours and at the commencement of my shift now complaining of more discomfort, I thought it wise to check her. At our hospital the policy is a care provider must be present, does not specify OB. The medwives office is on hospital grounds and that qualifies ( in the hospital's eyes ) as "on the premises". No, I did not feel a cord on my check of a posterior 4cm. cervix. I suspect she had been walking around at that same 4 cm. for a few days. That was my point..........she was not in labor and should not have been ruptured artificially before the head was engaged in the pelvis. Variable decels are just that and were getting deeper and longer and the baby was getting tachy upon recovery which tells me he was in stress. Obviously the cord was being compressed. My feeling is it would not have had a chance to precede the vertex if the medwife had waited for engagement. Also, I do not like my concerns minimized by arrogant care providers. I am quite proud of myself for acting quickly in an emergency AND for not saying "I told you so".

[SmilingBluEyes]

Where I work, in order to do ANY kind of induction of labor, a physician provider with c-section priveleges must be made aware of it and be available for back-up within, I believe, 10 minutes from start of emergency to cut time . This would mean backup for midwives and/or family practice docs who are not qualified to do the c/s themselves. Any place not ensuring this is playing a dangerous sort of roulette IMO. That said,a cord prolapse is a very sickening kind of emergency that no one wants to see, and thank goodness, rarely does. Knowing exactly what to do is what is needed to save lives....and having solid policies in effect is also key.

To the OP, I sure hope you accomplished a variance/incident report detailing everything clearly.

[midwife228]

I'm sorry you had such a scary experience, as a prolapsed cord always is! I am especially sorry that the AROM was done by a medwife. As a midwife (please note the difference!) I never AROM unless the baby's head is well-applied to the cervix. I have worked in private practice and now as a staff midwife in a busy L&D unit - both places where docs wanted me to AROM under questionable circumstances; I'm sure they may be annoyed when I don't do it but I don't want to find myself in the circumstance you describe. EVER.