POUC,FD,BPRESENATTION

Prolapsed of the Umbilical Cord Therapeutic Management

Note: Cord prolapse leads to cord compression.
•In umbilical cord prolapse, a loop of the umbilical cord slips down in front of
-Management is aimed at relieving pressure on the cord (fetal anoxia)
the presenting fetal part.
-This may be done by placing a gloved hand in the vagina and manually elevating the
Prolapse may occur at any time after the membranes rupture if the presenting
fetal head off the cord, or by placing the woman in a knee–chest or modified
fetal part is not fitted firmly into the cervix.
Trendelenburg position.
It tends to occur most often with: How to relieve
 wear gloves
 lift and elevate manually fetal head off the cord
 Premature rupture of membranes  Position in knee to chest Position – the gravity is in the chest of the mother
 Fetal presentation other than cephalic
 Placenta previa -Administering O2 at 10 L/min by face mask
 Intrauterine tumors preventing the presenting part from engaging -A tocolytic agent may be prescribed to reduce uterine activity and pressure on the
 A small fetus fetus Tocolytic agent drugs -> (prevent contraction)
 Cephalopelvic disproportion preventing firm engagement Types:
 Terbutalin
 Hydramnios – used to open the airway(bronchodilator) I
– It affect the uterus to prevent contract
 Multiple gestation  Niphediphine
– calcium channel blocker
– Used to reduce urine activity not for blood pressure
Assessment  Endomacine
– Used to till prevent contraction of the uterus
-the cord may be felt as the presenting part on an initial vaginal
examination during labor. -If the cord exposed to room air, drying will begin (umbilical atrophy)
-identified on UTZ (CS is necessary before rupture of the membranes occurs)
-Do not attempt to push any exposed cord back into the vagina (may add compression)
Why do we need to CS before rupture? - because to prevent chord compression

Pag nauna ang chord bababa ang bp :”If 101 fetal heart rate suspect chord compression” -cover any exposed portion with a sterile saline compress to prevent drying
What is umbilical atrophy?
 In delivery room, assess the umbilical cord. What to do to prevent drying
-if ruptured membrane occurs, the cord slides down into the vagina from We should prevent drying by:
 get gauze pad
the pressure exerted by the amniotic fluid (deceleration FHR pattern,  put plain NSS(sterile water)
cord may be visible at the vulva)  cover the umbilical cord
-To prevent drying of the cord
-to rule out cord prolapse, always assess FHSs immediately after rupture What happen if umbilical cord dry?
-begin to umbilical atrophy
of the membranes.
POUC,FD,BPRESENATTION
-If the cervix is fully dilated at the time of the prolapse, forceps delivery is Assessment Findings:
recommended (prevent fetal anoxia)
 FHT above 160 or below 120/min
-If dilatation is incomplete, upward pressure on the presenting part, applied by a  Meconium-stained amniotic fluid in a non-breech presentation
practitioner’s hand in the woman’s vagina, until the baby can be born by CS.  Fetal hypermobility/hyperactivity
Meconium
Amnioinfusion -why there a M in relation to fetal distress
The anal sphincter will relaxed (it will able to open)
-is the addition of a sterile saline fluid into the uterus to supplement the amniotic fluid Since the oxygen level decrease the anal sphincter relaxed that’s why there is a passage of Me conium
When a baby keeps on moving or hyper mobility is a sign of fetal death
(prevents additional cord compression)
Interventions:
Amnioinfusion
It is a Artificial amniotic
 just use plain NSS or sterile saline
• Reposition mother to left lateral recumbent.(to prevent compression of inferior
 Put in the uterus vena cava)
This relieves pressure on inferior vena cava, thereby, increasing venous return
resulting in increased perfusion of placenta and fetus
Fetal Distress Supine position- decreased oxygen inferior vena cava dahil naiipit ang inferior
Left lateral- nadidisplace increasing venous return in vena cava
-fetal condition resulting from fetal hypoxia.
Risk Factors:
• Stop oxytocin drip if being infused.
 Dystocia – prolonged labour/difficult labour
• Administer O2 per mask @ 6-7L/min.
 Cord coil, cord compression- or nuchal cord
 Improper use of oxytocin, analgesia/anesthesia • Correct hypotension:
 DM, cardiac disease- blood cant pu,p well oxygenated blood
 elevate legs (good circulation in the heart)
 Bleeding complications in 3rd trimester (PP & AP)
 IV rate (increase hydration) provided that 18IVF is plain and w/ no
 PIH
oxytocin.
 Supine hypoten sivesyndrome(compression of vena cava
 turn mother in LLR if it is a case of VC
How to know if fetal distress
 decreased oxygen level(hypoxia) IV rate (increase hydration) provided that 18IVF is plain and w/ no oxytocin.
 poor perfusion  used PLAIN NSS (.9 sodium chloride)
 Fetal hypoxia  to hydrate the mother
“Anoxia(absence of oxygen)”
Oxytocin toxicity may lead to:
 Used to contract
 Decreased of oxygen level
POUC,FD,BPRESENATTION

Interventions:
• Monitor FHT continuously.
• Notify the physician.
• Prepare for emergency CS if indicated. Cause of breech
Monitor FHT continuously - depends in severity  Hydromules
Increased 120-160 lead to FD  Myoma
 Mass
 Pendulous abdomen

Breech Presentation
-Most fetuses are in a breech presentation early in pregnancy.
-However, by week 38, a fetus normally turns to a cephalic presentation Breech presentation is more hazardous to a fetus than a cephalic presentation,
because there is a higher risk of:
 Anoxia from a prolapsed cord
 Traumatic injury to the after coming head (possibility of intracranial
hemorrhage or anoxia)
 Fracture of the spine or arm
 Dysfunctional labor
 Early rupture of the membranes because of the poor fit of the presenting
part.
Assessment
• FHSs usually are heard high in the abdomen.
• Leopold’s maneuvers and a vaginal examination usually reveal the presentation.
• UTZ clearly confirms a breech presentation
 First maneuver: fundal grip. While facing the woman, palpate the woman's upper
abdomen with both hands. ...(it should be soft and moves with the trunks)
 Second maneuver: lateral grip. ...(side of the abdomen an d feel long and flat or numerous
angular)
Fetal lie refers to the relationship between the long axis  Third maneuver: second pelvic grip or Pawlik's grip. ...(L gesture)(malift un head and its
of the fetus with respect to the long axis of the mother. moving
Fetal attitude - degree of flexion of the fetus  Fourth maneuver: Leopold's first pelvic grip.
POUC,FD,BPRESENATTION
Birth Technique
-If an infant will be born vaginally, a woman is allowed to push after full
dilatation is achieved.
-it is steadied and supported by a sterile towel held against the infant’s inferior
surface.
the baby is positioned head-down, facing your back, with the chin tucked to its chest and the
back of the head ready to enter the pelvis. This is called cephalic presentation. Most babies
settle into this position with the 32nd and 36th week of pregnancy.

Intraintestinial hemorrhage – brough about by compression or pressure and puputok ang ugat ng
bata cause bleading

Breech Presentation
-A frank breech position infant tends to keep his or her legs extended and at the
level of the face for the first 2 or 3 days of life.
-A footling breech infant may tend to keep the legs extended in a footling position
for the first few days.
Breech is prone lo meconium stain
 Because of contraction and compression of fetal buttocks inside the pelvis that’s why there
is meconium stained