Faculty Opinions recommendation of Emergency Cesarean delivery for umbilical cord prolapse: the head-down, knee-chest prone position for spinal anesthesia.

Bernard Wittels
2003 ◽  
Vol 10 (1) ◽  
pp. 43-46
CY Hung ◽  
P Ng ◽  
HH Yau ◽  
CW Kam

Cord prolapse is an obstetric emergency as delay in management is associated with significantly increased neonatal morbidity and mortality. If the accident occurred outside the hospital, many babies would be dead or severely asphyxiated upon arrival in the hospital. The role of Accident & Emergency (A&E) department is to arrive at this diagnosis promptly and deliver appropriate intervention. Immediate cesarean delivery is the treatment of choice. The clinical presentations of two cases with umbilical cord prolapse presenting to our A&E department within two weeks were described. The pathophysiology, risk factors, diagnosis, management as well as outcome were discussed.

2003 ◽  
Vol 84 (2) ◽  
pp. 127-132 ◽  
B. Kahana ◽  
E. Sheiner ◽  
A. Levy ◽  
S. Lazer ◽  
M. Mazor

2018 ◽  
Vol 08 (02) ◽  
pp. e89-e94 ◽  
Tetsuya Kawakita ◽  
Chun-Chih Huang ◽  
Helain Landy

Objective The aim of the study was to examine the association between cervical exam at the time of artificial rupture of membranes (AROM) and cord prolapse. Study Design We conducted a retrospective cohort study using the data from the Consortium on Safe Labor. We included women with cephalic presentation and singleton pregnancies at ≥ 23 weeks' gestation who underwent AROM during the course of labor. Multivariable logistic regression was used to calculate the adjusted odds ratio (aOR) with 95% confidence interval (95% CI), controlling for prespecified covariates. Results Of 57,204 women who underwent AROM, cord prolapse occurred in 113 (0.2%). Compared with dilation 6 to 10 cm + station ≥ 0 at the time of AROM, <6 cm + any station and 6–10 cm + station ≤ −3 were associated with increased risks of cord prolapse (<6 cm + station ≤ −3 [aOR, 2.29; 95% CI, 1.02–5.40]; <6 cm + station −2.5 to −0.5 [aOR, 2.34; 95% CI, 1.23–4.97]; <6 cm + station ≥ 0 [aOR, 3.31; 95% CI, 1.39–8.09]; and 6–10 cm + station ≤ −3 [aOR, 5.47; 95% CI, 1.35–17.48]). Conclusion Cervical dilation < 6 cm with any station and 6 to 10 cm with station ≤ −3 were associated with a higher risk of cord prolapse.

Sabine Bousleiman ◽  
Dwight J. Rouse ◽  
Cynthia Gyamfi-Bannerman ◽  
Yongmei Huang ◽  
Mary E. D'Alton ◽  

Objective This study aimed to assess risk for fetal acidemia, low Apgar scores, and hypoxic ischemic encephalopathy based on decision-to-incision time interval in the setting of emergency cesarean delivery. Study Design This unplanned secondary analysis of the Maternal–Fetal Medicine Units prospective observational cesarean registry dataset evaluated risk for hypoxic ischemic encephalopathy, umbilical cord pH ≤7.0, and Apgar score ≤4 at 5 minutes based on decision-to-incision time for emergency cesarean deliveries. Cesarean occurring for nonreassuring fetal heart rate monitoring, bleeding previa, nonreassuring antepartum testing, placental abruption, or cord prolapse was classified as emergent. Decision-to-incision time was categorized as <10 minutes, 10 to <20 minutes, 20 to <30 minutes, 30 to <50 minutes, or ≥50 minutes. As secondary outcomes umbilical cord pH ≤7.1, umbilical artery pH ≤7.0, and Apgar score ≤5 at 5 minutes were analyzed. Results Of 5,784 women included in the primary analysis, 12.4% had a decision-to-incision interval ≤10 minutes, 20.2% 11 to 20 minutes, 14.9% 21 to 30 minutes, 18.2% 31 to 50 minutes, and 16.5% >50 minutes. Risk for umbilical cord pH ≤7.0 was highest at ≤10 and 11 to 20 minutes (10.2 and 7.9%, respectively), and lowest at 21 to 30 minutes (3.9%), 31 to 50 minutes (3.9%), and >50 minutes (3.5%) (p < 0.01). Risk for Apgar scores ≤4 at 5 minutes was also higher with decision-to-incision intervals ≤10 and 11 to 20 minutes (4.3 and 4.4%, respectively) compared with intervals of 21 to 30 minutes (1.7%), 31 to 50 minutes (2.1%), and >50 minutes (2.0%) (p < 0.01). Hypoxic ischemic encephalopathy occurred in 1.5 and 1.0% of women with decision-to-incision intervals of ≤10 and 11 to 20 minutes compared with 0.3 and 0.5% for women with decision-to-incision intervals of 21 to 30 minutes and 31 to 50 minutes (p = 0.04). Risk for secondary outcomes was also higher with shorter decision-to-incision intervals. Conclusion Shorter decision-to-incision times were associated with increased risk for adverse outcomes in the setting of emergency cesarean. Key Points

1997 ◽  
Vol 176 (6) ◽  
pp. 1181-1185 ◽  
William E. Roberts ◽  
Rick W. Martin ◽  
Holli H. Roach ◽  
Kenneth G. Perry ◽  
James N. Martin ◽  

2019 ◽  
Vol 34 (s1) ◽  
pp. s155-s155
Vaclav Jordan

Introduction:Spontaneous delivery is a completely physiological phenomenon. Occupational obstetric care in a hospital environment focuses on supporting the mother, the smooth progression of the baby, and the treatment of the newborn child. Occupational activities play a rather supportive and assisting role. The obstetrician and the midwife are ready to respond immediately in the hospital environment to any complications or sudden emergencies. During a birth outside of the hospital environment, there are a number of influences that can cause complications in an unprepared environment without professional assistance, endangering the condition of both the child and the woman.Methods:The educational concept of PARABORN focuses on situations outside the hospital environment. It is generalized and adaptable to varying geographic, economic, and cultural-political conditions of the target providers, particularly to rescue and paramedic teams. Educational concepts are specialized, interactive courses. The course includes a theoretical and practical block. In the theoretical part, the participants acquire knowledge of urgent obstetric conditions in an out-of-hospital environment including an overweight birth, bleeding, premature delivery, or a complicated delivery (non-standard position, umbilical cord prolapse, etc.). In the practical block, participants acquire the skills of acute interventions as well as methods of communication in these emergency situations. Practical training takes the form of case studies and can be tailored to the real geographic and cultural conditions in which the intervention units operate such as remote terrain, conflicts zones, etc.Discussion:The knowledge of the cultural and political environment is a necessary prerequisite for managing the urgent situation. Paramedics, as first responders, should have adequate training to manage maternity situations in an out-of-hospital environment where a hospital environment is not available or accessible either by choice or circumstance.

1998 ◽  
Vol 53 (9) ◽  
pp. 529-531 ◽  
Anne-Marie Prabulos ◽  
Elliot H. Philipson

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