• Vigilant observations in labour, especially in trial and induction of labour are necessary. You should be able to recognise,at an early stage, signs of obstructed labour and ruptured uterus. • Maternal education is important in case of risk factors such as a previous scar. • The community should be educated on pregnancy and childbirth complications. They should be advised on the need to deliver in a hospital rather than at home. Prevention of Uterus Rupture
• This is a condition where the cord lies in front of the presenting part BEFORE the membranes have ruptured • This is diagnosed on vaginal examination when the cord is felt behind intact membranes CORD PRESENTATION
• Under no circumstance should the membranes be ruptured. • The midwife should discontinue the vaginal examination in order to reduce the risk of rupturing the membranes • Continuous foetal heart monitoring • Help the mother adopt a position that will reduce the likelihood of cord compression Mgt of cord presentation
• Cord prolapse is a term used when the umbilical cord lies in front of the presenting part AFTER the membranes have ruptured. CORD PROLAPSE
Diagnosis of cord presentation and cord prolapse is made on: • Vaginal examination by palpating cord under the intact membranes (cord presentation) • Vaginal examination after rupture of the membranes reveals loops of the cord in the birth canal (cord prolapse).
• Premature rupture of the amniotic sac • Polyhydramnios (having a large volume of amniotic fluid. The cord may be forced out with the more forceful gush of waters. • Long umbilical cord • Foetal malpresentation • Multiparity • Multiple gestation Potential predisposing risk factors
Differential Diagnosis • Foetal membranes • Footling breech or compound presentations. CONT…
• Any condition in which the presenting part does not fit well into the lower uterine segment will permit the umbilical cord to slip down in front of the presenting part, for example, malpresentation and malposition, breech presentation, face and brow presentation, shoulder presentation resulting from transverse lie and occipito posterior position Causes of Cord Prolapse
• Contracted pelvis: because the membranes may rupture before the head has engaged. • Certain placental and cord conditions like low implantation of the placenta, • marginal insertion of the cord and a long cord. • High head: the membranes rupture spontaneously when the foetal still high • Prematurity: there is more room between the small foetal head and the maternal pelvis. • Polyhydramnios: the cord is likely to be swept down in a gush of liquor when the membranes rupture spontaneously. ct…
Emergency Treatment • The aim of management is to deliver the foetus as quickly as possible before hypoxia and death occurs due to cord compression.
- Fall '16