Re: Prolapsed cord
From: Efrain Ramirez (eramirezt@coqui.net)
Thu Feb 23 14:01:43 2006
I agree - it's just funic presentation - at that gestational age there
is nothing you can do - there is nothing "prolapsing" into .. the only
other wording that comes into mind - in labor - "occult prolapse"??
"Viability" depends a lot on you nursery.. hospitals should have
protocols addressing those issues –
Ef
>At Thu, 23 Feb 2006, art fougner, md wrote:
>
>Thank the radiologist very much for reporting a finding that sounds
>horrendous and for which there is NO management plan. Most likely this
>will not result in real cord accident. This finding is akin to nuchal
>cord at same gestational age.
>
>Of course that's just my opinion. I could be wrong.
>
>Art
>
>At Thu, 23 Feb 2006, Len2976@aol.com wrote:
>>
>>Our patient is a 23 y/o G3, P2002 at 22 1/2 weeks. Yesterday we recieved a
>>handwritten preliminary faxed U/S report:
>>
>> "Viable IUP at 22-23 weeks
>> FHTs 153
>> Cephalic presentation
>> Possible cord prolapse into cervical os."
>>
>>The patient's first 2 pregnancies were uneventful. This pregnancy has been
>>significant for 1st trimester bleeding attributed to a LLP on U/S. Recently
>>she has noted intermittant spotting and cramping. When I showed the report
>>to the obstetrician (1 OB, 3 CNM practice) his immediate thought was that she
>>had had a SROM, while I wondered about a placenta previa or an incompetant
>>cervix.
>>
>>I called the patient in to L&D and spoke to the radiologist to get more
>>information. He said there was no previa, a normal AFI, a cervical length of > 4
>>cms. Our U/S department may not always identify small abruptions or
>>subchorionic bleeds. The radiologist said he was quite sure about the prolapsing
>>cord as they had visualized it using dopplar.
>>
>>The patient was (currently) experiencing no bleeding or cramping and her
>>cervix was LTC. Our present management was to observe her overnight and repeat
>>the U/S today. If the results are the same--??? The obstetrician suggested
>>a perinatal consult. I know from past experience that the local high risk
>>facility will not take a facility to facility transfer at 22-23 weeks as they
>>consider it pre-viable. The other option would be to make her an appt.
>>(likely next week) in the high risk clinic.
>>
>>We would appreciate any other thoughts or suggestions.
>>
>>Lenora McCall, CNM
>>Spring Hill, Fl
>
>--
>art fougner, md
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