tailieunhanh - obstetrics_part5

Dây rốn giảm xuống ở phía trước của phần trình bày, thường là khi vỡ màng (do chèn thấp hoặc chiều dài quá mức, trình bày ngang hay ngôi mông, đột ngột vỡ túi ối, nước ối dư thừa, mang thai sinh đôi). | 4. Normal delivery and usual procedures for various problems Prolapsed cord The umbilical cord drops in front of the presenting part usually when the membranes rupture due to low insertion or excessive length transverse or breech presentation sudden rupture of the amniotic sac excess amniotic fluid twin pregnancy . Compression of the cord between maternal tissues and the foetus during contractions causes foetal distress and rapid foetal death Figures 29 and 30 . Diagnosis - Amniotic sac has ruptured cord can be felt between the fingers and if the foetus is still alive pulsations can be felt. - Foetal distress foetal heartbeat is slow and irregular. Management Foetus is dead or nonviable extremely premature No specific intervention delivery no caesarean section Foetus is alive Obstetric emergency deliver immediately - The woman in knee-chest Figure 31 or Trendelenburg dorsal decubitus head down position to take the pressure off the cord. - With one hand inserted into the vagina push the presenting part toward the uterine fundus to relieve pressure on the cord and hold until caesarean section. - Caesarean section holding the presenting part off of the cord via the vagina until extraction. Check for a foetal heartbeat right before the procedure. If heartbeat is no longer heard it is better to let vaginal delivery proceed the infant is already dead . - If the presenting part is engaged and the cervix fully dilated it will not be possible to push the presenting part back perform vaginal extraction quickly instrument extraction vacuum extractor or forceps or total breech extraction. 4 Figure 29 Cord coming out of the vaginal opening This is trial version 85 Prolapsed cord Figure 30 Compression of the cord by the presenting part Figure 31 Knee-chest position This is trial version 4. Normal delivery and usual procedures for various problems Nuchal cord The umbilical cord is looped around the neck of the foetus this can cause foetal .