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Cord Prolapse

Cord Prolapse and Breech.

QuestionAnswer
Define cord prolapse. The descent of the umbilical cord through the cervix alongside or past the presenting part in the presence of ruptured membranes.
Is cord prolapse common? No it is rare with an incidence of 1:426.
Is perinatal mortality high with cord prolapse? Yes with an incidence of 91:1000.
What is the most common form of breech presentation? Footling Breech.
What are the three types of breech presentation from highest to lowest incidence? Footling, Complete Breech,Frank Breech.
What is vertex fetal position? Head first, the most desirable position.
What factors contribute to cord prolapse? Malpresentation. High presenting part. Prematurity - <2550g or <37/40. Polyhydramnios. Long cord. Mulriparity. Multiple gestation, second twin. Iutrogenic - manipulation, artificial membrane rupture. Placental issues-praevia, abruption.
Is it more likely for a before term breech to become cephalic spontaneously? Yes.
What are the chances of having a breech with a preterm <2500g? 12%
What are the chances of having a breech with a normal term baby? 1%
What are the chances of having a breech with a full term baby >3500g? 12%.
What are the complications of vaginal birth? Cord prolapse, Entrapment of the fetal head, Deflexed head, Pressure on the cord in the first stage. Increased incidences of premature placental separation.
What are the main causes of morbidity in vaginal breech birth? Intracranial haemorrhage, Asphyxia, Hypoxia, Fractures.
What fractures are seen in vaginal breech birth? Humerous, Clavicle, Femur, Cervical spine.
Define lithotomy. Position in which the patient is on their back with hips and knees flexed and thighs apart.
Define brachial plexus injuries, common in breech with nuchal arms presentation. Injury of the network of nerves that conducts signals from the spinal cord, which is housed in the spinal canal of the vertebral column ,to the shoulder, arm and hand.
Define nuchal arms. This is when one or both arms are causing obstruction.
What maneuver is used for nuchal presentation? Loveset's Maneuver.
What may be the cause of fetal head entrapment? The cervix may not be fully dilated.
Is head entrapment more common with preterm babies and why? Yes, because their heads are significantly larger than their heads, preterm babies are also smaller than normal permitting birth faster than normal, eg cervix is not fully dilated yet.
Created by: boermedic