Prolapsed Umbilical Cord A prolapsed umbilical cord is a medical
emergency that occurs when the umbilical cord slips through the cervix and
into the vagina ahead of the baby, potentially cutting off the baby’s oxygen
supply.
Signs and Symptoms of Prolapsed Umbilical Cord
Sudden fetal bradycardia: A sudden drop in the fetal heart rate.
Recurrent variable decelerations: These become progressively
more severe.
Feeling or seeing the cord: The mother may feel the cord in her
vagina or see it protruding.
Fetal distress: Decreased fetal movement or abnormal positioning.
Prioritized Interventions for Prolapsed Umbilical Cord
1. Call for Help Immediately:
o Do not leave the woman alone. Call for immediate assistance.
2. Inform the Woman:
o Explain what is happening and discuss options with her
healthcare provider.
3. Relieve Cord Compression:
o Manual Elevation: Insert a sterile gloved hand into the vagina
and hold the presenting part off the umbilical cord until delivery.
o Positioning: Change the woman’s position to a modified Sims,
Trendelenburg, or knee-chest position to help relieve cord
pressure.
4. Monitor Fetal Heart Rate (FHR):
o Continuously monitor the FHR to assess for signs of fetal distress.
5. Administer Oxygen:
o Provide oxygen to the mother to maximize oxygen delivery to the
fetus.
6. Prepare for Emergency Cesarean Birth:
o If the mother’s cervix is not fully dilated, prepare for an
emergency cesarean birth to save the fetus’s life.
7. Emotional Support:
o Provide emotional support and explanations to allay the woman’s
fears and anxiety.
8. Do Not Attempt to Replace the Cord:
o Do not attempt to push the cord back into the uterus.
,Preterm labor signs and symptoms to watch for:
Change in vaginal discharge: This could be an increase in discharge
or a change in its consistency, such as becoming watery, mucus-like,
or bloody.
Pelvic pressure: A sensation of pressure or a “pushing-down” feeling
in the pelvis.
Low, dull backache: Persistent pain in the lower back that may come
and go or remain constant.
Menstrual-like cramps: Cramps that feel similar to menstrual
cramps.
Urinary tract infection symptoms: These can include a burning
sensation during urination or frequent urination.
Gastrointestinal upset: Nausea, vomiting, and diarrhea can also be
signs.
General discomfort: A general sense of unease or feeling that
something is not right.
Heaviness or aching in the thighs.
Uterine contractions: These can occur with or without pain and are
more frequent than six contractions per hour.
Intestinal cramping: This can occur with or without diarrhea.
Heartburn, however, is NOT related to preterm labor.
Preterm labor interventions:
Medical Interventions
1. Tocolytic Medications: These drugs help suppress uterine
contractions. Common tocolytics include:
o Magnesium sulfate: Used to relax the uterus and protect the
fetal brain.
o Nifedipine: A calcium channel blocker that reduces
contractions.
o Terbutaline: A beta-adrenergic agonist that helps relax uterine
muscles.
Usage and Monitoring of Tocolytic Medications
1. Magnesium Sulfate
Usage: Administered to relax the uterus and protect the fetal brain,
particularly in cases of preterm labor before 32 weeks of gestation.
When to Stop: Discontinue if there are signs of toxicity such as
respiratory depression, absent deep tendon reflexes (DTRs), or urine
output less than 30 mL/hr.
Vital Signs Monitoring:
o Respiratory rate: Should be above 12 breaths per minute.
o Urine output: Should be monitored hourly.
o Deep tendon reflexes: Checked regularly.
o Magnesium levels: Monitored to avoid toxicity.
2. Nifedipine
Usage: A calcium channel blocker used to reduce uterine contractions,
often preferred for its oral administration.
When to Stop: Discontinue if there is severe hypotension or signs of
cardiovascular instability.
, Vital Signs Monitoring:
o Blood pressure: Monitored closely to detect hypotension.
o Heart rate: Regularly checked to ensure stability.
3. Terbutaline
Usage: A beta-adrenergic agonist that helps relax uterine muscles,
typically used for short-term management of preterm labor.
When to Stop: Discontinue if maternal heart rate exceeds 120 beats
per minute, or if there are signs of pulmonary edema or significant
cardiovascular side effects.
Vital Signs Monitoring:
o Heart rate: Monitored before and after each dose.
o Respiratory rate: Should be below 30 breaths per minute.
o Blood glucose levels: Monitored due to the risk of
hyperglycemia.
General Guidelines for Tocolytic Use
Duration: Tocolytics are generally used for 48-72 hours to delay labor
long enough to administer corticosteroids for fetal lung maturity.
Contraindications: Avoid use in cases of severe preeclampsia,
placental abruption, or intrauterine infection.
Corticosteroids: Administered to accelerate fetal lung maturity if preterm
birth seems imminent
Progesterone Supplementation: Used for women with a history of
preterm birth or a short cervix to help maintain pregnancy.
Lifestyle Modifications
1. Activity Restriction: Bed rest or reduced physical activity can help
decrease the risk of preterm labor.
2. Hydration: Ensuring adequate fluid intake to prevent dehydration,
which can trigger contractions
3. Avoiding Stress: Stress management techniques such as relaxation
exercises, counseling, and support groups.
1. Healthy Lifestyle Choices: Encouraging a balanced diet, avoiding
smoking, alcohol, and illicit drugs.
emergency that occurs when the umbilical cord slips through the cervix and
into the vagina ahead of the baby, potentially cutting off the baby’s oxygen
supply.
Signs and Symptoms of Prolapsed Umbilical Cord
Sudden fetal bradycardia: A sudden drop in the fetal heart rate.
Recurrent variable decelerations: These become progressively
more severe.
Feeling or seeing the cord: The mother may feel the cord in her
vagina or see it protruding.
Fetal distress: Decreased fetal movement or abnormal positioning.
Prioritized Interventions for Prolapsed Umbilical Cord
1. Call for Help Immediately:
o Do not leave the woman alone. Call for immediate assistance.
2. Inform the Woman:
o Explain what is happening and discuss options with her
healthcare provider.
3. Relieve Cord Compression:
o Manual Elevation: Insert a sterile gloved hand into the vagina
and hold the presenting part off the umbilical cord until delivery.
o Positioning: Change the woman’s position to a modified Sims,
Trendelenburg, or knee-chest position to help relieve cord
pressure.
4. Monitor Fetal Heart Rate (FHR):
o Continuously monitor the FHR to assess for signs of fetal distress.
5. Administer Oxygen:
o Provide oxygen to the mother to maximize oxygen delivery to the
fetus.
6. Prepare for Emergency Cesarean Birth:
o If the mother’s cervix is not fully dilated, prepare for an
emergency cesarean birth to save the fetus’s life.
7. Emotional Support:
o Provide emotional support and explanations to allay the woman’s
fears and anxiety.
8. Do Not Attempt to Replace the Cord:
o Do not attempt to push the cord back into the uterus.
,Preterm labor signs and symptoms to watch for:
Change in vaginal discharge: This could be an increase in discharge
or a change in its consistency, such as becoming watery, mucus-like,
or bloody.
Pelvic pressure: A sensation of pressure or a “pushing-down” feeling
in the pelvis.
Low, dull backache: Persistent pain in the lower back that may come
and go or remain constant.
Menstrual-like cramps: Cramps that feel similar to menstrual
cramps.
Urinary tract infection symptoms: These can include a burning
sensation during urination or frequent urination.
Gastrointestinal upset: Nausea, vomiting, and diarrhea can also be
signs.
General discomfort: A general sense of unease or feeling that
something is not right.
Heaviness or aching in the thighs.
Uterine contractions: These can occur with or without pain and are
more frequent than six contractions per hour.
Intestinal cramping: This can occur with or without diarrhea.
Heartburn, however, is NOT related to preterm labor.
Preterm labor interventions:
Medical Interventions
1. Tocolytic Medications: These drugs help suppress uterine
contractions. Common tocolytics include:
o Magnesium sulfate: Used to relax the uterus and protect the
fetal brain.
o Nifedipine: A calcium channel blocker that reduces
contractions.
o Terbutaline: A beta-adrenergic agonist that helps relax uterine
muscles.
Usage and Monitoring of Tocolytic Medications
1. Magnesium Sulfate
Usage: Administered to relax the uterus and protect the fetal brain,
particularly in cases of preterm labor before 32 weeks of gestation.
When to Stop: Discontinue if there are signs of toxicity such as
respiratory depression, absent deep tendon reflexes (DTRs), or urine
output less than 30 mL/hr.
Vital Signs Monitoring:
o Respiratory rate: Should be above 12 breaths per minute.
o Urine output: Should be monitored hourly.
o Deep tendon reflexes: Checked regularly.
o Magnesium levels: Monitored to avoid toxicity.
2. Nifedipine
Usage: A calcium channel blocker used to reduce uterine contractions,
often preferred for its oral administration.
When to Stop: Discontinue if there is severe hypotension or signs of
cardiovascular instability.
, Vital Signs Monitoring:
o Blood pressure: Monitored closely to detect hypotension.
o Heart rate: Regularly checked to ensure stability.
3. Terbutaline
Usage: A beta-adrenergic agonist that helps relax uterine muscles,
typically used for short-term management of preterm labor.
When to Stop: Discontinue if maternal heart rate exceeds 120 beats
per minute, or if there are signs of pulmonary edema or significant
cardiovascular side effects.
Vital Signs Monitoring:
o Heart rate: Monitored before and after each dose.
o Respiratory rate: Should be below 30 breaths per minute.
o Blood glucose levels: Monitored due to the risk of
hyperglycemia.
General Guidelines for Tocolytic Use
Duration: Tocolytics are generally used for 48-72 hours to delay labor
long enough to administer corticosteroids for fetal lung maturity.
Contraindications: Avoid use in cases of severe preeclampsia,
placental abruption, or intrauterine infection.
Corticosteroids: Administered to accelerate fetal lung maturity if preterm
birth seems imminent
Progesterone Supplementation: Used for women with a history of
preterm birth or a short cervix to help maintain pregnancy.
Lifestyle Modifications
1. Activity Restriction: Bed rest or reduced physical activity can help
decrease the risk of preterm labor.
2. Hydration: Ensuring adequate fluid intake to prevent dehydration,
which can trigger contractions
3. Avoiding Stress: Stress management techniques such as relaxation
exercises, counseling, and support groups.
1. Healthy Lifestyle Choices: Encouraging a balanced diet, avoiding
smoking, alcohol, and illicit drugs.
