HI!

GOOD DAY, THIS IS DARWIN

QUIRIMIT YOUR STUDENT NURSE IN-
CHARGED FOR TODAY & I WILL BE
DEMONSTRATING EMERGENCY
MANAGEMENT FOR PROLAPSE OF
UMBILICAL CORD.
PROLASE OF THE UMBILICAL CORD:
 PROLAPSE MAY OCCUR AT ANY
TIME AFTER THE MEMBRANE
RUPTURE IF THE PRESENTING
FETAL PART IS NOT FITTED FIRMLY
AND TO THE CERVIX.
IT TENDS TO OCCUR MOST UP THEN
WITH:
 PREMATURE RUPTURE OF
MRMBRANE
 FETAL PRESENTATION OTHER
THAN CEPHALIC
 PLACENTA PREVIA
 INTRAUTERINE TUMORS
PREVENTING THE PRESENTING
PART FORM ENGAGING.
 A SMALL FETUS
 CPD PREVENTING FIRM
ENGAGEMENT
 POLYHYDRAMINOS
 MULTIPLE GESTATION
FOR THE ASSESSMENT:
 ASSESS THE WOMAN TO BE
TRANSFERRED TO THE NEAREST
CONSULTANT UNIT/HOSPITAL FOR
DELIVERY; AND
 ASSESS THE CLIENT’S ABILITY TO
FOLLOW INSTRUCTIONS.

SO LET’S START…

1) I WILL GATHER ALL ITEMS THAT I

WILL NEED ON THIS PROCEDURE.
FOR THE VAGINAL DELIVERY: FOR THE
INTERNAL
 2 STERILE GLOVES EXAMINATION:
 1 STRAIGHT FORCEPS - CLEAN GLOVES;
AND
 1 MAYO SCISSORS - LUBRICANT
 URINARY CATHETER
 PLACENTAL BASIN
 1 NEEDLE HOLDER
 1 SYRINGE W/ NEEDLE
 1 CHROMIC 2
 2% LIDOCAINE
 COTTON BALLS W/ BETADINE
 STERILE OPERATING SPONGE
THIS PROCEDURE IS IMPORTANT FOR EASY
ACCESSIBILITY FOR THE INSPECTION OF
THE EXTERNAL GENTITALIA, VAGINA, &
CERVIX
2) HI MA’AM, GOOD DAY I AM
DARWIN THE STUDENT NURSE FOR
TODAY. MAY I KNOW YOUR NAME
IS? THANK YOU. AND I WILL DO
INTERNAL EXAMINATION TO
ASSESS THE PROGESS OF YOUR
LABOR.
IT IS IMPORTANT TO OBTAIN CLIENT’S
COOPERATION & WORK
SIMULTANEOUSLY.
3) MAAM, YOU WILL BE PLACED ON
THE EXAMINATION TABLE TO
INSPECT YOUR LABOR PROGRESS.
ASSESS THE CLIENT THERE 3
POSITIONS ARE EMPLOYED FOR
INTERNAL EXAMINATION:
- DORSAL RECUMBENT, SIM’S
 POSITION AND KNEE-CHEST
POSITION
THE AFOREMENTIONED POSITIONS ARE
MADE BEST SO AS TO EXPOSE THE
GYNECOLOGIC AREA TO BE EXAMINED.
AND POSITON DEPENDS ON CLIENT’S
CAPABILITY & EXAMINER’S PREFERRED
POSITION.
4) I WILL DRAPE THE CLIENT &
EXPOSE ONLY THE
GYNECOLOGICAL AREA.
ALWAYS RESPECT THE CLIENT’S MODESTY AND
PROVIDE PRIVACY.
5) NEXT, I WILL DO HANDWASHING
AND PUT THE EXAMANITION
GLOVES. THIS WILL PROTECT
MYSELF FROM CONTACTING
GYNECOLOGICAL DISEASES CAUSED
BY HIGHLY INFECTIVE ORGANISMS.

6) MA’AM, PLEASE TAKE A DEEP

BREATH WHILE I INSERT MY TWO
FINGERS AND PERFORM THE
INTERNAL EXAMINATION. IF I SEE A
 CORD PROTRUDING ON THE VAGINA
I WILL HANDLE IT CAREFULLY.
ON INSPECTION THE CORD WILL BE
VISIBLE AT THE VULVA AND TO ASSESS
THE CORD FOR PULPATIONS.

7) I WILL NOW CHECK YOUR BABY'S

HEART RATE WITH THE
STETHOSCOPE ON YOUR ABDOMEN.

- CORD PROLAPSE IS IDENTIFIED ON A

FETAL MONITOR ONLY AFTER THE
MEMBRANES HAVE RUPTURED, WHEN
THE FHR IS DISCOVERED TO BE
UNUSUALLY SLOW OR A VARIABLE
DECELERATION FHR PATTERN.
-TO ELIMINATE CORD PROLAPSE,
ALWAYS EVALUATE FETAL HEART
SOUNDS IMMEDIATELY AFTER
MEMBRANE
RUPTURE, WHETHER SPONTANEOUS OR
AMNIOTOMY.
“IF YOU’RE IN A CEMONC (OR
COMPREHENSIVE EMERGENCY
OBSTETRIC AND NEW BORN CARE)
FACILITY REPORT THE FINDINGS TO
THE OBSTETRICIAN FOR EMERGENCY
CESAREAN SECTION”
BUT, “IF YOU’RE IN A BEMONC (OR
BASIC EMERGENCY OBSTETRIC AND
NEW BORN CARE) FACILITY THE
FOLLOWING PROCEDURES BELOW ARE
EMERGENCY MANAGEMENT FOR
PROLAPSE OF THE UMBILICAL CORD.

8) MA'AM, I WILL ASSIST YOU IN

GETTING INTO A KNEE CHEST
POSITION, TAKE A DEEP BREATHE,
AND DO NOT BEAR DOWN IF YOU
HAVE TO.
KNEE-CHEST POSITION AND USES
GRAVITY TO SHIFT THE FETUS OUT THE
PELVIS.
9) MA’AM I WILL BE INSERTING
CATHETER INTO YOUR URINARY
BLADDER BY A STERILE FLUID TO
HELP IN REDUCING THE COMPRESSION
ON THE PROLAPSE CORD.
- SO LET’S ASSUME THAT THEIR HAS
STERILE IV FLUIDS. THEN THE
CATHETER SHOULD BE CLAMP ONCE
500-700ML HAVE BEEN INSTILLED
- BEFORE ANY DELIVERY ATTEMPT,
WHETHER VAGINAL OR CESAREAN
SECTION (CS), IT IS ESSENTIAL TO RE-
EMPTY THE BLADDER

10)MAAM, I WILL PUT MY GLOVED

HANDS INTO YOUR VAGINA TO PUSH
THE HEAD OF YOUR BABY UPWARD &
TAKE A DEEP BREATH WHEN YOU
HAVE THE URGE TO BEAR DOWN.
- IT IS IMPORTANT TO NOT REMOVE
YOUR FINGERS UNTIL YOU ARRIVED IN
THE OPERATING ROOM OR BY
INSTRUCTION OF THE OBSTETRICIAN.

11) AFTER THE CS, CALL OUT THE

TIME OF BIRTH AND GENDER OF
THE BABY. IF THE BABY IS CRYING I
WILL PROCEED TO EINC BUT IF NOT
I WILL CUT THE CORD &
 RESUSCITATE THE INFANT IF
NEEDED.
THIS WILL PROTECT THE MOTHER AND
THE BABY FROM INFECTION AND
ALLOW THE INFANT TO BREATHE ON
HIS OWN.
12) AFTER THE PROCEDURE I WILL
REMOVE THE GLOVES AND WASH
MY HANDS FOR INFECTION
CONTROL.
13) FINALLY, IN ORDER TO PROVIDE
ACCURATE DATA IN THE CLIENT'S
CARE, I WILL DOCUMENT THE
DATE, TIME, AND PROCEDURE.

THAT’S ALL THANK YOU FOR

LISTENING!!

10. MAAM, I WILL PUT MY GLOVED HANDS INTO

YOUR VAGINA TO PUSH THE HEAD OF YOUR
BABY UPWARD & TAKE A DEEP BREATH WHEN
YOU HAVE THE URGE TO BEAR DOWN.
- IT IS IMPORTANT TO NOT REMOVE YOUR
FINGERS UNTIL YOU ARRIVED IN THE
OPERATING ROOM OR BY INSTRUCTION OF
THE OBSTETRICIAN.
RATIONALE:
• Elevation of the presenting part is
thought to relieve pressure on the
umbilical cord and prevent mechanical
vascular occlusion.
• Manual elevation is performed by
inserting a gloved hand or two fingers in
the vagina and pushing the presenting part
upwards.
• Excessive displacement may encourage
more cord to prolapse
• To prevent vasospasm, there should be
minimal handling of loops of cord lying
outside the vagina.