Prolaps Tali Pusat

Definition

Prolapsed umbilical cord is located next to or passing through the lowest part of the fetus in the birth canal after rupture

Classification

a. Leading umbilical cord b. The funiculi prolapsc.Occult prolapsed

Etiology

Etiology of fetal

• Most of the umbilical cord in the presentation : 1. Location of latitude 2. Location of breech breech presentation , especially the

buttocks legs. • Prematurity Often abnormal position in premature

labor , one of which caused a small baby . • Gemeli

Factors affecting include adaptation disorders , abnormal presentation frequency greater

• Polyhydramnios When it breaks, a large amount of fluid flowing out and the umbilical cord downward

b . etiology maternal • Pelvic disproportion head.

Disproportion between the pelvis and the baby 's head can not get off cause rupture of the membranes

• The lowest part high Delays in the head for a while can occur despite normal pelvis

c . Etiology umbilical cord and placenta • The umbilical cord that extends• The placenta lies low If the placenta is near the cervix

will block the reduction in the lowest part . Besides, the insertion of the umbilical cord closer to the cervix

Diaqnosis

May involve a number of ways :

• View the cord out of the vaginal introitus • Palpable by chance the cord when the checks in • Aukultasi

FHR sounds irregular , often with bradycardia clear , especially associated with uterine contractions • FHR continuous monitoring showed variable decelerations • Pressure on the lowest part of the fetus by external manipulation of the PAP cause a sudden drop in fetal

Complication

a. maternal May cause intra- partum infection , rupture of the membranes causing bacteria in the amniotic fluid amniotic penetrate and invade the decidua and chorionic vessels , causing bacteremia and sepsis in the mother and fetus .

b . fetal * fetal distress* Cerebral palsy : is a disorder that affects the muscles , movement and motor skills as a result of muscle damage due to birth trauma or intrauterine pathology

Patofisilogi

• Pressure on the cord occurs because the lowest part of the fetus and the birth canal . This leads to a reduction or disappearance of circulation to the placenta can cause fetal death

• If there is complete obstruction of the umbilical cord , it will lower the FHR , and if the obstruction continues , then against myocardial hypoxia , and deselarisasi long and eventually death of the fetus .

• And if the obstruction is partial , causing FHR acceleration , causing hypovolemia due to the closure v . umbilicus precedes arterial closure .

• And if an interruption of blood flow long cord , causing respiratory and metabolic acidosis resulting reduced oxygenation of the fetus and cause persistent bradycardia and eventual death of the fetus .

Management and therapy

• definitive therapy : Giving birth the fetus immediately • Positioning mother to tredelenburg position to reduce the pressure of the umbilical cord • Always monitored heart rate and umbilical cord • intrauterine resuscitation through oxygenation in his mother• Encouraging the lowest part of the fetus toward cranial to reduce pressure on the cord • vaginal delivery soon : Only when the full opening , the lowest part of the fetus has entered the pelvis , no CPD . • Perform SC at the opening of the incomplete • Minimize the pressure of the lowest part of the fetus to the cord by means of knee chest position • If previously given oxytocin , stop drug administration • Perform vaginal SC if the terms have not been reached.

Prognosis

• maternal complications such as birth canal laceration , uterine rupture , due to anesthesia , anemia and infection can occur as a result of efforts to save the baby . • fetal prognosis improved with SC liberal for cord prolapse therapy