Umbilical Cord Prolapse

SESSION 1.
PROLAPSE OF THE UMBILICAL CORD

DESCRIPTION
• Prola~e may occ~r at any time after the membranes rupture if the presenting fetal part is not fitted
firmly into the ceMx.
It tends to occur most often with:
• Premature rupture. of membranes

• Fetal presentation other than cephalic
• Placenta previa
lrttlawfi8rilletumoa~ l i e ~ part from angaging
• A small fetus
• CPD preventing firm engagement
• Polyhydramnios
• Multiple gestation
T_ he incidence is about 0.5%: of cephalic births but can rise as high as 10% or higher with breech or transverse
1 ,es.
EMERGENCY MANAGEMENT FOR PROLAPSE OF UMBILICAL CORD

PROCEDURE SCRIPT FOR RETURN DEMONSTRATION
1. Gather all items you will need for the internal Good morning/good aflemoon! I will demonstrate the
examination and prepare for double set-up. emergency management for prolapse of the umbilical
cord.
For internal examination First, I will gather all items that I will need on this
Clean gloves procedure.
lubricant
For Vaginal delivery (depends on institutional set-up)

2 sterile gloves
1 straight forceps
1 mayo scissors
1 urinary catheter
1 placental basin
1 needle holder
Sterile OS
1 syringe with needles
1 chromic 210 (optionaQ
2% Lidocaine (optional)
Cotton balls with betadine
RATIONALE:
For easy accessibility for the inspection of the
external enitalia va ina and cervix.
2. Identify the client, introduce yourself and explain Good mominglaflemoonlevening ma'am. I am
the procedure (mention your name) and I will be your nurse for the
~RA
_ TI
_ O_N_AL
__E__:- - - - - - - - - - - - - - 1 day. I will do intematexamination to assess the
progress of your labor
To obtain cJienrs cooperation and work
simunaneousl .
N U R 14 6 R L E c I in Ic a I I n s t r u c t o r ' s G u I d e 7 I 91
3. Position the client on the examination table. (Ma 'sm you will be positioned on the examination
•Three positlOns ar:e employed for Internal table to cMck·for the prog/'9ss of yout labor)
examination:
• Dorsal Recumbent
• Sim's -Position
• Knee-chest Position
RATIONALE:
The eforementioned positions ere msde best so as
to expose the gynecologic erea to be examined.
Position depends on client's capability and

examiner's referred osition.
4. Drape the client. Expose only the gynecological
area. Ma'am I will put the drape on you and will expose the
f-=-7=-=:-:--:--=---------------1 part that I only need to assess.
RATIONALE:
Always respect the client's modesty and to provide
rivac .
""5=-·-=-W=-::as:--::h-:-h::--:a:-:n=-d_s_-_a_nd~_ut~-o~n....c..ex""a__m--i.:..:.n;::;at::..:io:..:..n:...=lo=--v:..:ec::s.:...----1 I will do handwashing then I will put on examination
RATIONALE: gloves for the intemal examination and I will change
To protect the health care provider from contracting into sterile gloves after I assess your progress of labor
gynecological diseases caused by highly infective
o~ anisms.
6. Assess the well-being of the pregnant woman if Ma'am while I insert my 2 fingers kindly take a deep
the cord is visible outside of the vagina or can be felt breath while I do the internal examination.
in the vagina below the presenting part. Handle the
cord carefully. DO NOT PINCH THE CORD If I see a cord protruding on the vagina ;/ wiil handle it
.___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____. Ca/'9ful/y.
RATIONALE:
On inspection, the cord may be visible at the vulva
and to assess the cord for u/sations
After performing internal examination: I will now be assessing the Heart Rate of your baby by
· - · · - - putting-:tfffitetffosci5pe'piffouY-abdqroen:--, :" . 0 •
,~~~zrerqsJ:;~=-c~ ---_-1:· .:!:.::~·s#:f::~?.=:~ '!''~-~ ~
2
~7~~ ~t~
_Fetal.Heart.Rate _ · -· - - --
apparent on a fetal monitor.
To rule out cord prolapse, always assess fetal heart

sounds immediately after rupture of the membranes,
whether this occurs spontaneously or by amniotomy.
*IF YOU ARE IN A CEMONC FACILITY REPORT THE FINDINGS TO THE OBSTETRICIAN FOR
EMERGENCY CESAREAN SECTION.
*IF YOU ARE IN A BEMONC FACILITY THE FOLLOWING PROCEDURES BELOW ARE THE
EMERGENCY MANAGEMENT FOR PROLAPSE OF THE UMBILICAL CORD
8. Assist the mother to do knee-chest, head tilt, left Ma'am I will assist you in a knee-chest position, take a
lateral position and instruct the mother to take deep deep breath and do not bear down if you have the
breath and control the urge to bear down urge to do so.
RATIONALE:
Knee-chest position and uses gravity to shift the
fetus out of the peMs. (as shown below)
Modi&t4 Simi l'o!ilioa
(Put on sterile gloves before doing the procedl/re Ma'am I will be inserting a catheter that will inflate
below) your bladder by a sterile fluid to help in reducing the
compression on the prolapse cord.
9. Elevate the presenting part by filling the urinary
bladder by inserting a catheter. Instruct the client not
to bear down. as shown below
RATIONALE:
• If the decision-to-delivery interval is likely to be
prolonged, particularly ff it involves ambulance
transfer, elevation through bladder filling may be
more practical.
• Bladder filling can be achieved quickly by inserting
the cut end of an intravenous giving set into a
Foley's catheter.
• The catheter should be clamped once 500-750 ml
have been instilled.
• It is essential to empty the bladder again just before
any delivery attempt, be it vaginal or caesarean
section.
1O. Elevate the presenting part by inserting your Ma'am I will put my gloved hands into your vagina to
fingers into the vagina and push the head of the push the head of your baby upward and take a deep
fetus upward (DO NOT REMOVE your fingers until breath when you have the urge to bear down
you arrived at the operating room or by
Instruction of the obstetrician as seen below
RATIONALE:
Elevation of the presenting part is thought to relieve
pressure on the umbilical cord and prevent
mechanical vascular occlusion.
• Manual elevation is performed by inserting a gloved
hand or two fin ers in the va ina and ushin the
NUR 146 RLE Clinical I n s t r u c to r' s G u I d e 9 I 91
presenting part,upwards.
• Exce~e displacement may encourage more cord
to-prolapse.
hand/in oft .. . . ..
To prevent vasospasm; there should be minimal
,
t----==-:--:-:-:--=----__c;.;~-=..c.=.....,c.::.:..:.=:.-=-.:....::..:..::=-=::::.L:.--1
I• II; I I I I - I• • - • • - • I will call out the time of birth and gender of the
newborn.
To safeguard mother and baby against infection. If the newborn is with good cry I will proceed with
To facilitate spontaneous breathing of the infant. EINC if its not crying I will cut the cord and
resuscitate the infant if needed.
12. Remove gloves and wash -hands. After the procedure I will remove my_g/oves and wash
1----------------------J my hands.
RATIONALE:
For in~tion control
·13_ Document th1flfate, time and the procedures that After the procedure I will dociimentthe date; tiine and
1-=w..,.as~do,...,n""'"e.,.,t,...,o=-th_e_._a_t_ie_n_t_ _ _ _ _ _ _ _ _ _-1 the procedure.
RATJONALE:
., .;t_i,i ,yi_~g_1Jratadataja..tbe..ca_m.,,ofJb&~-f;f'e ._t,,,__
-NI.UC-IJRl.~;~_1,1p_1Q_EJ11)i p~l,ritt) , , , _,; ,/ ,·-. -
-Ar;i,swer;;;tli~!Olr(lV{IDQ"QU~t•Qfl.S; c- -~,c-c:- -
C. Placenta previa
D. A small fetus
E. CPD preventing firm engagement
2. Dayanara, a pregnant client is admitted to the Emergency Room Department and was transfer to
your area. She told you that her membranes ruptured on the way to the hospital and there is something
on her vagina that feels like rope. Upon initial assessment it is umbilical cord prolapse. Which of the
following is the nurse's initial action when umbilical cord prolapse occurs?
A. Begin monitoring maternal vital signs and FHR
B. Place the client in a knee-chest position in bed
C. Notify the physician and prepare the client for delivery
D. Apply a sterile warm saline dressing to the exposed cord
3. When assessing Dayanara, the nurse will check the progress of her labor. The nurse should positior
her: SELECT ALL THAT APPLy
A. Dorsal Recumbent
B. Sim's Position
C. Knee-chest Position
D. Modified Sim's Position
4. When assessing Dayanara, the nurse finds a prolapsed cord. The nurse should:
A. Attempt to replace the cord
B. Place the client on her left side
C. Elevate the client's hips
Q_ Cover the cord with a dry, sterile gauze

Umbilical Cord Prolapse

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SESSION 1.

PROLAPSE OF THE UMBILICAL CORD

It tends to occur most often with:

• Premature rupture. of membranes

EMERGENCY MANAGEMENT FOR PROLAPSE OF UMBILICAL CORD

For Vaginal delivery (depends on institutional set-up)

Position depends on client's capability and

apparent on a fetal monitor.

To rule out cord prolapse, always assess fetal heart

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