Clinical Practice Procedures: Obstetrics/Nuchal umbilical cord
Transcription
Clinical Practice Procedures: Obstetrics/Nuchal umbilical cord
Clinical Practice Procedures: Obstetrics/Nuchal umbilical cord Disclaimer and copyright ©2016 Queensland Government All rights reserved. Without limiting the reservation of copyright, no person shall reproduce, store in a retrieval system or transmit in any form, or by any means, part or the whole of the Queensland Ambulance Service (‘QAS’) Clinical practice manual (‘CPM’) without the priorwritten permission of the Commissioner. The QAS accepts no responsibility for any modification, redistribution or use of the CPM or any part thereof. The CPM is expressly intended for use by QAS paramedics whenperforming duties and delivering ambulance services for, and on behalf of, the QAS. Under no circumstances will the QAS, its employees or agents, be liable for any loss, injury, claim, liability or damages of any kind resulting from the unauthorised use of, or reliance upon the CPM or its contents. While effort has been made to contact all copyright owners this has not always been possible. The QAS would welcome notification from any copyright holder who has been omitted or incorrectly acknowledged. All feedback and suggestions are welcome, please forward to: [email protected] Date April, 2016 Purpose To ensure a consistent procedural approach for Nuchal umbilical cord. Scope Author Applies to all QAS clinical staff. Clinical Quality & Patient Safety Unit, QAS Review date April, 2018 URL https://ambulance.qld.gov.au/clinical.html This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. Nuchal umbilical cord April, 2016 Nuchal cords occur in 20% to 30% of births, and most babies will deliver without incident. Clamping and cutting the umbilical cord prior to delivery of the neonate should be avoided and only be considered as a last resort. Indications UNCONTROLLED WHEN PRINTED • Umbilical cord wrapped around the neonates head Contraindications UNCONTROLLED WHEN PRINTED • Nil Complications • hypoxic-ischemic encephalopathy UNCONTROLLED WHEN PRINTED • cerebral palsy [1] UNCONTROLLED WHEN PRINTED Figure 3.72 QUEENSLAND AMBULANCE SERVICE 562 Procedure – Nuchal umbilical cord The essential element for the management of a nuchal cord (cord around the neonate’s neck) is avoiding the early clamping or cutting the cord, before the neonate’s body is delivered: UNCONTROLLED WHEN PRINTED 1. If the cord is loose, slip it over the head (cord reduction). 2. If the cord is too tight to slip over the baby's head but not tight around the neck, slip it over the shoulders as the baby's body is born and deliver the baby through the cord. UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED 563 Procedure – Nuchal umbilical cord 3. If the cord is too tight to slip back over the shoulders, but has a little give to it, somersault the baby out, as follows: a) Slowly deliver both shoulders without manipulating the cord. c) Deliver the baby’s body flexing torso gently and somersaulting out. UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED b) As the shoulders are delivered, flex the baby's head so the face is pushed toward the mother's thigh. d) Loosen the cord and commence newly born assessment and cares. 564
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