Cord Prolapse 4

8/17/2019 Cord Prolapse 4

1/31


2/31

UMBILICAL CORD PROLAPSE

Aboubakr Elnashar

Prof . Obs Gyn, Benha Uniersi!y "os#i!alAboubakr Elnashar

RCOG, $%%&


3/31

Defini!ionCor' #rola#se(

)or' !hrou*h !he )eri+ alon*si'e o))ul!- or#as! !he #resen!in* #ar! oer!- in !he #resen)e ofru#!ure' ebranes.

Cor' #resen!a!ion(

)or' belo/ #resen!in* #ar! /i!h in!a)! ebranes

Aboubakr Elnashar


4/31Aboubakr Elnashar


5/31

In)i'en)e

Cor' #rola#se(

%.01 2 %.31.

Bree)h #resen!a!ion(

01.

Aboubakr Elnashar


6/31

Perina!al or!ali!y ra!e

4050%%%.

Prea!uri!y )on*eni!al alfora!ions

bir!h as#hy+iaAs#hy+ia(

6)or' )o#ression an' ubili)al ar!erial asos#as(#reen!in* enous an' ar!erial bloo' flo/ !o an' fro

!he fe!us7(hy#o+i)8is)haei) en)e#halo#a!hy an'

)erebral #alsy.

Aboubakr Elnashar


7/31

Risk fa)!ors

General

9Mul!i#ari!y9Lo/ bir!h /ei*h! :$.; k*-9Prea!uri!y :e!al )on*eni!al anoalies9Bree)h #resen!a!ion

9?ranserse, obli@ue an' uns!ablelie9Polyhy'ranios9Lo/2lyin* #la)en!a, o!herabnoral #la)en!a!ion9Unen*a*e' #resen!in* #ar!9Se)on' !/in

Pro)e'ure rela!e' ;%1

9ARM9a*inal ani#ula!ion of!he fe!us /i!h ru#!ure'ebranes9EC 'urin* #ro)e'ure-9In!ernal #o'ali) ersion9S!abilisin* in'u)!ion oflabour9Inser!ion of u!erine#ressure !rans'u)er

Aboubakr Elnashar


8/31

"o/(0. Preen!in* )lose a##li)a!ion of !he #resen!in*

#ar! !o !he lo/er #ar! of !he u!erus an'5or #eli)bri.

$. Ru#!ure of ebranes


9/31

De!e)!ion of )or' #resen!a!ion an!ena!ally

Rou!ine US(

no! suffi)ien!ly sensi!ie or s#e)ifi)(shoul' no! be #erfore'

Aboubakr Elnashar


10/31

Preen!ion of )or' #rola#se or i!s effe)!s

0. A'ission if

a. ?ranserse, obli@ue or uns!able lie af!er


11/31


12/31

Sus#i)ion of )or' #rola#se

Abnoral >"R #a!!ern

bra'y)ar'ia, ariable 'e)elera!ions, #rolon*e' 'e)elera!ion

#ar!i)ularly af!er ebrane ru#!ure, s#on!aneously or /i!h anio!oy.

Aboubakr Elnashar


13/31

S#e)ulu an'5or 'i*i!al a*inal e+aina!ion shoul'be #erfore'

0. A! #re!er *es!a!ions /hen )or' #rola#se is

sus#e)!e'.$. In labour(af!er s#on!aneous ru#!ure of ebranes if

risk fa)!ors are #resen! or if

C?G abnorali!ies )oen)e soon !hereaf!er.

o nee'(

i!h s#on!aneous ru#!ure of ebranes in !he#resen)e of a noral >"R #a!!erns an' !he

absen)e of risk fa)!ors for )or' #rola#se,li@uor is )lear.

Aboubakr Elnashar


14/31

Do no! han'le )or' !oo u)h.

Assess( )eri)al 'ila!a!ion

#ulsa!in* or no!H. If non #ulsa!in*(

Che)k fe!al hear! soun's

US( assess hear! a)!ii!y

Aboubakr Elnashar


15/31

Ini!ial ana*een! of )or' #rola#se in

hos#i!al

0. Assis!an)e shoul' be ie'ia!ely )alle'$. Pre#ara!ions a'e for ie'ia!e 'elieryManual re#la)een! of !he #rola#se' )or' aboe

!he #resen!in* #ar! !o allo/ )on!inua!ion of labour is

no! re)oen'e'.


16/31

. Preen! )or' )o#ression(

#resen!in* #ar! be elea!e' ei!heranually or by

fillin* !he urinary bla''er.knee8)hes! #osi!ion or

hea'2'o/n !il! #referably in lef!2la!eral #osi!ion-.;. ?o)olysis

/hile #re#arin* for CS if !here are#ersis!en! >"R abnorali!ies af!er a!!e#!s !o

#reen! )o#ression e)hani)ally an' /hen !he'eliery is likely !o be 'elaye'.

Aboubakr Elnashar


17/31

Aboubakr Elnashar


18/31

S/abs soake' in /ar saline are /ra##e'aroun' !he )or'( un#roen benefi!.

Manual elea!ion(By inser!in* a *loe' han' or !/o fin*ers in !he

a*ina an' #ushin* !he #resen!in* #ar! u#/ar's.A aria!ion is !o reoe !he han' fro !he a*ina

on)e !he #resen!in* #ar! is aboe !he #eli) bri

an' a##ly )on!inuous su#ra#ubi) #ressureu#/ar's.

E+)essie 'is#la)een! ay en)oura*e ore)or' !o #rola#se.

Aboubakr Elnashar


19/31

Bla''er fillin*If !he 'e)ision2!o2'eliery in!eral is likely !o be

#rolon*e', #ar!i)ularly if i! inoles abulan)e!ransfer

Mo'era!e ?ren'elenbur* #osi!ion.By inser!in* !he en' of a bloo' *iin* se! in!o a

>oleys )a!he!er. ?he )a!he!er shoul' be )la#e'

on)e ;%%8=;% l has been ins!ille'.E#!y !he bla''er a*ain us! before any 'eliery

a!!e#!, be i! a*inal or CS.

Aboubakr Elnashar


20/31

?o)olysis6re'u)e )on!ra)!ions an' abolish bra'y)ar'ia7

?erbu!aline( %.$; * SC

Aboubakr Elnashar


21/31

Mo'e of 'eliery /i!h )or' #rola#se

0. CS

/hen a*inal 'eliery is no! iinen! 6#reen! hy#o+ia8a)i'osis7.$. a*inal(

hen a*inal bir!h is iinen! 6ou!)oes aresiilar or be!!er /hen )o#are' /i!h CS7.

Aboubakr Elnashar


22/31

CS(

Ca!e*ory 0(Delierin* /i!hin "Rbu! /i!hou! un'uly riskin* a!ernal safe!y.

erbal )onsen! is sa!isfa)!ory.Ca!e*ory $(

>"R is noral.?he ou!)oe for eer*en)y CS is no! /orse for

'elieries o))urrin* u# !o 3% in fro 'e)ision,#roi'e' !ha! !he si!ua!ion is no! ie'ia!ely life2

!hrea!enin* for !he fe!us

Aboubakr Elnashar


23/31

Ca!e*ory 0Eer*en)y

Ie'ia!e !hrea! !o !he life of a /oan or fe!us.

Ca!e*ory $Ur*en!Ma!ernal or fe!al )o#roise bu! no! ie'ia!ely life!hrea!enin*.

Ca!e*ory


24/31

Re*ional anaes!hesiaay be )onsi'ere' in )onsul!a!ion /i!h an

e+#erien)e' anaes!he!is!. 6i!h o'ern!e)hni@ues, !he )o#li)a!ions of *eneral

anaes!hesia are rare bu! s!ill hi*her !han forre*ional anaes!hesia.

?he use of !e#orary easures, as 'es)ribe'

aboe, )an re'u)e )or' )o#ression, akin*

re*ional anaes!hesia !he !e)hni@ue of )hoi)e.7Re#ea!e' a!!e#!s a! re*ional anaes!hesia

shoul' be aoi'e'.

Aboubakr Elnashar


25/31

a*inal bir!h

Mos! )ases o#era!ieery faourable )hara)!eris!i)s(

full )eri)al 'ila!a!ion'eliery /oul' be a))o#lishe' @ui)kly an' safely.

De)ision2!o2'eliery in!eral(


26/31

Bree)h e+!ra)!ion(

JPerfore' af!er in!ernal #o'ali) ersion for !hese)on' !/in.

>or)e#s or en!ouse(De#en' on )lini)al )ir)us!an)es an' leel of skill.

o 'ifferen)e in neona!al ou!)oes for fe!al'is!ress

Aboubakr Elnashar


27/31

eona!al )are

eona!olo*is! shoul' a!!en'Paire' )or' bloo' sa#les for #" an' base

e+)ess easureen!6s!ron* #re'i)!ie alue of a noral #aire' )or'

bloo' *as for !he e+)lusion of in!ra#ar!u rela!e'hy#o+i)8is)hei) brain 'aa*e7

Aboubakr Elnashar


28/31

Mana*een! in )ouni!y se!!in*s

0. ai!in* for hos#i!al !ransfer(knee8)hes! fa)e2'o/n #osi!ion

$. Durin* abulan)e !ransfer(lef!2la!eral #osi!ion

Elea!e #resen!in* #ar!( anual or bla''er fillin*Preen! asos#as( inial han'lin* of loo#s of

)or' lyin* ou!si'e !he a*ina.

Aboubakr Elnashar


29/31

Mana*een! of )or' #rola#se before iabili!y

oen shoul' be )ounselle' on bo!h )on!inua!ion an'!erina!ion of #re*nan)y

E+#e)!an! ana*een!Ges!a!ional a*e a! !he lii!s of iabili!y.U!erine )or' re#la)een! ay be a!!e#!e'.Prolon*a!ion of #re*nan)y a! su)h *es!a!ional a*es

)rea!es a )han)e of surial bu! orbi'i!y fro #rea!uri!y

reains a fre@uen! serious #roble.Deliery(si*ns of seere fe!al )o#roise

on)e iabili!y has been rea)he' or*es!a!ional a*e asso)ia!e' /i!h a reasonable neona!al

ou!)oe is a)hiee'.

,Aboubakr Elnashar


30/31

?rainin*

All s!aff inole' in a!erni!y )are shoul' re)eie a!

leas! annual !rainin* in !he ana*een! of

obs!e!ri) eer*en)ies in)lu'in* !he ana*een!of )or' #rola#se.

U#'a!es on !he ana*een! of obs!e!ri)eer*en)ies in)lu'in* !he in!er#re!a!ion of fe!al

hear! ra!e #a!!erns- are a #roa)!ie a##roa)h !orisk ana*een!.

All s!aff inole' in a!erni!y )are shoul' a!!en'annual ul!i'is)i#linary rehearsals skill 'rills-

in)lu'in* !he ana*een! of )or' #rola#se.

Aboubakr Elnashar

Clini)al in)i'en! re#or!in*


31/31

Clini)al in)i'en! fors shoul' be subi!!e' for all

)ases of )or' #rola#se.

Au'i!able s!an'ar's

0. Pro#or!ion of s!aff re)eiin* annual !rainin* in)or' #rola#se.$. Au'i! of !he ana*een! of )or' #rola#se in

hos#i!al se!!in*s.

Date post:	06-Jul-2018
Category:	Documents
Upload:	agronaslaughter
View:	225 times
Download:	0 times

Cord Prolapse 4

Documents