prolapsed cord

SoldierNurse22, BSN, RN · Apr 10, 2016

Yes, a contraction can cause variable decels. So can a wrapped cord (neck, body, or a variation thereof) or baby squeezing his or her cord.

Typically, a prolapsed cord does not cause variable decels. It causes a decline in the FHR d/t an interruption of fetal perfusion, and if untreated, results in death.

I can see an early prolapse potentially causing variables if baby's head isn't fully engaged in the maternal pelvis OR if baby's head isn't the presenting part. A contraction would push baby's head (or butt or feet) against the maternal pelvis and the pressure would somewhat relent when the contraction was over, but I wouldn't expect the FHR to return to baseline as in such a position, the pressure on the cord would never fully release. I would also think that such decels would be a very early and extremely short-lived phase of a rapid decline in FHR.

nfeese · Apr 10, 2016

See, that's my thought but my teacher said "cord compression" causes variable decels and threw prolapse on the list. Welp, I've researched and variable decels actually resolve and the FHR returns to baseline meaning perfusion is restored. So, I was like if the cord is continuously compressed, as I imagine it would be in prolapse, how does it return to baseline? What the crap. I believe ATI also has prolapse in the variable decel mix. Leaves me confuses

nfeese · Apr 10, 2016

Also, if a CTX is causing the compression, then why would it be a variable decel which I thought had nothing to do with a contraction??? Like variable decels aren't related to ctx and can happen anytime...

SoldierNurse22, BSN, RN · Apr 10, 2016

You're correct. Usually, a prolapsed cord won't cause a variable decel, but a prolonged decel (one that never returns to baseline and in the case of prolapse, usually continues to decline). The only time in which I can ever recall seeing variable decels with a prolapse was (as I mentioned in my first post) when the head was not the presenting part. Baby's feet were on the cord.

Variable decels may or may not be related to a contraction. They can happen at any time, but often, if you have decels happening with contractions, baby may have a cord wrapped somewhere or perhaps mom's position in bed, sitting up or walking is putting the cord in a position to get pinched with contractions.

nfeese · Apr 10, 2016

Ok, so if the decel is happening with the CTX as the cause wouldn't it then be classified as either late or early?

SoldierNurse22, BSN, RN · Apr 10, 2016

What makes a variable decel a variable decel is how quickly the FHR drops and subsequently recovers. Variable decels are rapid drops in FHR (more than 15bpm in 15 seconds) that recover within 2 minutes of when they begin.

On the other hand, early and late decels are both slower declines and returns in FHR and are defined as either early or late based on where they occur with respect to a contraction.

Electronic Fetal Heart Monitoring

Fetal Heart Monitoring: How to Make an L&D Nurse Run – Cervix With A Smile

mkk99 · Apr 10, 2016

Ok, so if the decel is happening with the CTX as the cause wouldn't it then be classified as either late or early?

If it takes less than 30 seconds to reach the nadir, it's a variable, not an early or late. This is my favorite site for definitions: Intrapartum Fetal Heart Rate Monitoring. You can see just by looking how different your average variable looks than your average early or late. One of my biggest pet peeves is when my nurses say a patient has "late variables" or "early variables" - it's one or the other! I feel like I see a lot of people nervous to call something a late (since these are thought to be 'more severe') and so try and stretch the definition of variable, but if you just look at how long it takes to reach the nadir, that's your best bet to differentiate.

TheCommuter, BSN, RN · Apr 11, 2016

Since the OP is a student, this thread has been moved to the Nursing Student Assistance forum.

nfeese · Apr 12, 2016

So, if it mirrors a CTX in respect to timing but appearance is rapid onset and recovery ud still call it a variable rather than an early? Also ATI suggests 8-10 L of O2 to mom for a prolapsed cord... um I hardly see the necessity. If moms o2 sat are fine, which I'd imagine they are, giving her excess O2 isn't going to help the baby or increase her sat level. It also suggests bolus fluids, and while this will raise moms BP, I'm not making a connection of how this will help the fetus. The kinked cord is still gonna be kinked and baby is still only gonna have some much flow toward the placenta to be oxygenated by mom. I mean u could raise moms bp 200 over 150 and if babys cord is kinked and only sending minimal rbc and flow to the placenta ur in the same mess?????? Please help I'm gonna scream

mkk99 · Apr 12, 2016

1) Yes, if it is less than 30 seconds to nadir, it is a variable, regardless of timing. Most often you are going to see them happen with contractions but not always.

2) I think you are confusing "prolapsed cord" with "cord occlusion." A prolapsed cord is a medical emergency. This is when the cord has come in front of the presenting part. You're going to be on your way to the OR as soon as you realize it. Cord occlusion that causes variables, however - I see some form of that with probably 90% of births. That can be baby squeezing the cord, laying on it wrong, the cord around the neck - all sorts of things. In a lot of cases this occlusion and these variables are temporary. Once baby gets past a certain point in the pelvis, or you turn mom a certain way - these resolve. Having a few variables is NOT a medical emergency in 99% of cases. Giving oxygen is thought to increase blood levels so that what blood DOES get through to baby is as oxygenated as possible. (And if mom is working hard and pushing you'd be surprised how her O2 sats can drop, especially if she's holding her breath while she pushes). Same with giving a bolus. Now, in reality, are those interventions going to completely and miraculously solve a tight nuchal cord? No. But are they gonna hurt? Probably not. And it feels better to do something than nothing.

If you want to read more, maybe check out this article on intrauterine resuscitation Intrauterine resuscitation during labor: review of current methods and supportive evidence. - PubMed - NCBI. But overall I think you're overthinking it! It's not an all or nothing situation - there's varying degrees of everything, and it's not a 1 size fits all solution - so for your test, yes, give oxygen and a bolus and reposition, but if you're thinking about becoming an OB nurse - it will all come with time.

SoldierNurse22, BSN, RN · Apr 12, 2016

So, if it mirrors a CTX in respect to timing but appearance is rapid onset and recovery ud still call it a variable rather than an early?

Correct.

Also ATI suggests 8-10 L of O2 to mom for a prolapsed cord... um I hardly see the necessity. If moms o2 sat are fine, which I'd imagine they are, giving her excess O2 isn't going to help the baby or increase her sat level. It also suggests bolus fluids, and while this will raise moms BP, I'm not making a connection of how this will help the fetus. The kinked cord is still gonna be kinked and baby is still only gonna have some much flow toward the placenta to be oxygenated by mom. I mean u could raise moms bp 200 over 150 and if babys cord is kinked and only sending minimal rbc and flow to the placenta ur in the same mess?????? Please help I'm gonna scream

I think you're missing one of the major interventions in a prolapse scenario: hold baby's presenting part off the cord! That means if you're the first one to discover the prolapse, you're going to have your hand in mom's lady parts holding baby off that cord until some helpful surgeon lifts baby's presenting part off your cramping, sore fingers by way of C-section.

So yes, bolus fluids and increasing O2 for mom makes nothing but sense in this scenario as you've likely got a very compromised soon-to-be-born fetus who will need the increase in mom's O2 sats and BP if he or she is going to live long enough to survive a prolapse.