Obstetric Emergencies: Cord Prolapse, Shoulder Dystocia

Definition: Descent of umbilical cord through the cervical os ahead of or alongside the presenting part. Types: - Complete (overt): Cord visible/palpable outside or at cervix - Occult: Cord alongside presenting part; not visible/palpable; diagnosed by FHR pattern - Funic presentation: Cord below presenting part with intact membranes Risk factors: - Rupture of membranes with high presenting part (unengaged head) - Prematurity (small fetus relative to pelvis) - Polyhydramnios - Breech presentation - Multiple gestation - Cord abnormalities (long cord) - Operative amniotomy with high presenting part - External version or internal manipulation Clinical presentation: - FHR changes: Sudden severe variable or prolonged deceleration/bradycardia AFTER AROM (artificial rupture of membranes) or spontaneous ROM - Visible or palpable cord at introitus - Patient may feel cord outside vagina EMERGENCY NURSING RESPONSE: 1. CALL FOR HELP immediately (code obstetric emergency) 2. Relieve cord compression — manual elevation of presenting part vaginally with examining hand (push baby UP — do NOT push cord back in): - Insert hand into vagina, cup presenting part, elevate off cord continuously - Maintain this position until delivery...