Case Study Term Paper (Term Paper Sample)

Case study
Positioning of the mother is one of the most important interventions. Appropriate positioning of the mother eases cord compression. Cord compression is associated with adverse fetal outcomes. Positions that have shown some effectiveness include knee-chest position, deep Trendelenburg position, and modified Sim’s position (Holbrook & Phelan, 2013). All these positions take advantage of gravity to relieve pressure on the prolapsed cord. Generally, a position is chosen based on individual needs. However, knee-chest position is the most widely recommended. It is a relatively easy position to adopt. The position allows the healthcare provider to maintain the hand supporting the presenting part in position. It is worth noting that it is not the only comfortable position for all patients.
Compression of prolapsed cord leads to reduction or loss of blood supply to the fetus. Fetal hypoxia and asphyxia may rapidly ensue. Depending on the extent of reduction in blood flow, the resulting hypoxia may be mild, moderate, or severe. A sudden change in fetal heart rate is a sign of fetal hypoxia. Severe hypoxia is associated with worse fetal outcomes (Kahana et al, 2004). It can cause either brain damage or fetal death (Kahana et al, 2004). Manipulation of the prolapsed cord leads to vasospasm. Vasospasm further reduces the blood flow to the fetus. Therefore, it is advisable to avoid unduly handling the cord. Brain damage resulting from hypoxia may cause cognitive problems later.
Risk factors for cord prolapse include the following:
High / ill-fitting presenting part- a high presenting part may allow a loose cord to either precede it or move alongside it.
Multi-parity- it causes abdominal wall muscles to be loose. This leads to the so-called pendulous abdomen (Perry, Hockenberry, Lowdermilk, Wilson, 2014).
Prematurity- a premature fetus occupies less space in the pelvis during delivery. In addition, there is a relative increase in amniotic fluid.
Multiple gestation- the cord may present owing to the limited space available for growth of more than one fetus.
Polyhydramnios- excessive amniotic fluid may allow the presenting part to ‘float’. This in turn may allow the cord to present.
Abnormal presentations- any presentation other than vertex presentation tends to increase the risk for cord presentation and cord prolapse.
Artificial rapture of membranes- artificial rapture of membranes should not be done when the presenting part is still high as this may give room for the cord to precede the presenting part of the fetus.
Intra-uterine growth restriction/ small for gestation age- a small fetus may be excessively mobile. Excessive mobility can permit the cord to precede the presenting part of the fetus.
Abnormal placentation- placenta previa and other anomalies of the placenta increase the likelihood of cord prolapse.
Obstetric manipulation- Obstetric manipulation refers to procedures like amniotomy and external cephalic version.
The fetal heart rate may either remain normal or become abnormal after umbilical cord prolapse. Abnormal fetal heart rate pattern may present as sudden deceleration with prolonged bradycardia, moderate deceleration, severe variable deceleration, and moderate to severe deceleration (Lin, 2006). These changes in fetal heart rate are because of hypoxia. Expedited delivery is the treatment of choice due to the dangers of hypoxia. The baby must be delivered promptly either via a cesarean section or via SVD if the situation allows.
Other immediate actions include supporting the presenting part to relieve pressure on the cord, calling for help, administering oxygen by mask, putting an intravenous cannula in situ, and drawing blood for full hemogram, grouping, and cross matching (Lin, 2006). However, elevation of the presenting part to reduce cord compression should come first. A second healthcare provider may carry out other interventions.
Unnecessary manipulation of the cord should be avoided. Handling of the cord may cause vasospasm (Lin, 2006). Vasospasm predisposes the fetus to worse outcomes. Debate on whether to return the cord into the vagina is ongoing. Some authors suggest that it should be returned while others advice that the cord should just be wrapped with a sterile gauze soaked in an isotonic solution like normal saline. However, none has been demonstrated to be superior. Both actions ensure that the cord remains moist. A dry cord is a risk factor for vasospasm. It is important to note that returning the cord into the vagina is not the same as returning it into the uterus. The later poses a greater danger to the fetus.
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