Umbilical Cord

AN ENCOUNTER WITH CORD PROLAPSE

SHE seemed just like any other patient when she was brought into the labour ward. I was informed by her minders that hers was a delivery emergency. I welcomed her and immediately requested her to change into a hospital gown as I took her details.

She gave her name as Elizabeth, 32, single, and working as a house help near the hospital.

Elizabeth said she was in labour and revealed that she had unsuccessfully attempted to deliver at home for the previous eight hours.

When she undressed, I saw that the umbilical cord was protruding from her vagina. This is a condition called cord prolapse, an obstetric emergency where the umbilical cord protrudes outside the vagina, after the membranes are broken either artificially or spontaneously.

I knew this would be an emergency Caesarean section. I urgently summoned my co-nurses and mobilised the theatre staff. The obstetrician was also alerted.

The theatre team proceeded to put resuscitation measures in place as it was clear the baby’s life might be in danger.

I instructed Elizabeth to lie on her back so that I could listen to the foetal heart beat. It was present, though slow and irregular. This meant that the foetus was in distress and at risk of intrauterine death.

I performed a vaginal examination to determine the dilation (opening) of the cervix and the presenting part (the part of the baby that was coming out first). I found that the cervix was fully dilated, but the reason Elizabeth had failed to deliver was that the baby was malpositioned.

The umbilical cord was still warm and pulsating. This meant that it was still performing its functions of supplying oxygen and nutrients to the foetus.

To maintain the functioning of the cord, I asked Elizabeth to lie crouching forwards on fours with knees and elbows folded, to prevent compression of the cord by the presenting part. I then ordered for some warm normal saline (sterile salt solution) in a container. I dipped a sterile towel into the solution and carefully covered the cord in it to prevent it from becoming cold. The cold would have caused the veins and artery to collapse hence the foetus would not get its nourishment.

I then placed pillows under the mother’s waistline to elevate the buttocks and prevent further compression of the cord by the presenting part. I also put her on an oxygen mask and instructed her to breathe in and out deeply to ensure maximum supply of oxygen to the foetus.

The obstetrician recommended immediate intravenous feeding with dextrose to supply energy to both mother and the foetus. As soon as the theatre team and obstetrician were ready to commence the operation, Elizabeth was rushed into the theatre for an emergency C-section.

Soon after, a male infant was born. The newborn was diagnosed to be suffering from a condition called asphyxia neonatorum, meaning inability to initiate breathing immediately after birth. Resuscitation measures were commenced. Glucose and sodium bicarbonate were administered in order to correct the PH (acidity) of the baby’s blood which falls below normal levels in cases of insufficient breathing and lack of oxygen. We also ensured the baby stayed warm.

By about five minutes after birth, we were all relieved by the obstetrician’s verdict that the baby was fairly stable. At around the tenth minute of his life, his breathing had improved significantly and he was declared out of danger.

The newborn was admitted in to the special baby care unit for further observation, where he could be medicated further and monitored round the clock for warmth and oxygen intake.

He stayed in the unit for three days during which he completely recovered from foetal distress. On the fourth day both mother and son were discharged from hospital.

Elizabeth left the hospital with a big smile, looking happy and grateful as she carried her newborn baby home.

END: PG8/10