Umbilical cord prolapsed

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Umbilical cord prolapsed

• Dr.Pramote Srikaew MD.
• Dip. Thai Broad OB-GYN
• Dip. Thai Broad Preventive Medicine

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Umbilical cord prolapsed
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UCP

• Overt cord prolapse
• 11000 live births
• 15 in footling breech
• 20 in transverse lie
• Occult cord prolapse
• 50 of Abnormal FH pattern
• Cord(Funic) presentation

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Risk Factors

• ???????????? ???????? ??????? ?????????????????
  Fix ???? rupture membrane
• Multiparity
• Low birth weight
• Prematurity
• Fetal congenital anomalies
• Breech presentation
• Malpresentation, transverse, oblique, unstable
  lie
• Polyhydramnios
• Low placenta

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Position related cord prolapsed
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Risk factors

• Procedure related
• - ?????????????????( artificial rupture of
  membrane)
• - ????????????????????????????????(ext. ceph.
  Version)
• - ????????????????????????????????(int. ceph.
  Version)
• - ????????????????(menaul rotation of fetal
  head)
• - ????????????? ???? ?????????????????(
  amnioinfusion or amnioreduction)

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??????????

• ?????????????????
• ?????????????????????????????????

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??????????????? ??? ???????????

• ?? severe, prolong fetal bradycardia ????
  moderated to severe variable deceleration
• ??????????????????? ???? pulsating cord
• ????????????????????????????
• ????? early DC ?? occult UCP

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Variable DC in Cord prolapsed
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????????????

• ??????????????????????? (Elevated of the
  presentation) ??????? mechanical vascular
  occlusion
• Manual elevation ???????????????????????
  ??????????????????????? ?????? continuous
  suprapubic pressure ??????????????????????
• Bladder filling ???????????????????????????????
  500-750 mL ?????????????? ???????????????
  Trendelenburg position ????????? ???? refer ????
  ?????? C/S ???

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????????????

• Materanal Posiotion Knee chest position ????
  head down tilt ???? exaggernerated Sim s
  position
• ???????????????????????????????(tocolytic)
  turbutaline 0.25 mg subcutaneously
  ????????????????????? ???? ??????
• ?????????????? (Funic reduction)
  ????????????????? ????????

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Knee chest position
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Exaggerated Sims position
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?????????????????? prolapsed cord

• Overt prolapse
• ?????? knee chest position( ???????????
  ???????????? ??????) ???????????????????? ??????
• ???????????????????????????? ?????????????????
  vasospasm
• ??? oxygen
• ???? oxytocin ?????
• ????????????????????????????
• ?????? ?????? ?????????????????????

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????????????

• Overt UCP
• ????????????????????
• ??? terbutaline 0.25 mg SC.
• ???????????????????????????????? ???
  ??????????????? ????????????? ???????????
  ???????????????????????????????????? ???????
  vacuum extraction ???? Forceps extraction
• ?????? neonatal resuscitation
• ??????????????? ??????????????????

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Vacuum extraction in cord prolapsed