Managing Complications in Pregnancy and Childbirth: - IAWG

PROLAPSED CORD S-97PROBLEMS• The umbilical cord lies in the birth canal below the fetal presentingpart.• The umbilical cord is visible at the vagina following rupture of themembranes.GENERAL MANAGEMENT• Give oxygen at 4–6 L per minute by mask or nasal cannulae.SPECIFIC MANAGEMENTPULSATING CORDIf the cord is pulsating, the fetus is alive.• Diagnose stage of labour by an immediate vaginal examination(Table C-8, page C-60).• If the woman is in the first stage of labour, in all cases:- Wearing high-level disinfected gloves, insert a hand into thevagina and push the presenting part up to decrease pressureon the cord and dislodge the presenting part from the pelvis;- Place the other hand on the abdomen in the suprapubic regionto keep the presenting part out of the pelvis;- Once the presenting part is firmly held above the pelvic brim,remove the other hand from the vagina. Keep the hand on theabdomen until caesarean section;- If available, give salbutamol 0.5 mg IV slowly over 2 minutes toreduce contractions;- Perform immediate caesarean section (page P-43).• If the woman is in the second stage of labour:- Expedite delivery with episiotomy (page P-71) and vacuumextraction (page P-27) or forceps (page P-33);