Why is a prolapsed cord an obstetrical emergency?

Lisa in Labor: An At-Risk Labor and Birth Case Study. On October 1st of the current year, L.G., a 16-year-old Caucasian female who is a G4 P0030, presents at a local hospital in labor. She reports that her due date is “the beginning of September of this year.” Based on her last menstrual period, her EDD is October 15th.

Coming to the labor and delivery unit alone, she states that she does not have any family or support. Upon further questioning, she states that a friend “gave me a ride and dropped me off here.” L.G. reveals during her admission assessment that she has had no prenatal care during this pregnancy. She reports that she’s been in labor at home for the past few hours but that the contractions got “too hard for me to breathe through them” so she came to the hospital.

A vaginal exam reveals that her cervix is 6 cm dilated, 80% effaced and her fetus is at the -2 station. Her amniotic membranes are intact and bulging and the fetal presenting part cannot be palpated. Her vital signs reveal BP 170/92, P 80, R 16, and T 98.8 degrees Fahrenheit. After you (the nurse) perform Leopold’s maneuvers, you place the fetal heart toco on the left upper quadrant of the patient’s abdomen.

Her uterine contraction pattern shows she is having contractions every 2-3 minutes lasting between 50 and 60 seconds. When you palpate the fundus during contractions, her fundus palpates firm.

Answer the following questions:

• What stage of labor is L.G. experiencing?
• What are six additional questions that you would ask L.G. in order to complete her admission assessment, including questions regarding her prenatal health history and factors that take her psychosocial, emotional support, and cultural factors into consideration? Write and discuss why you chose these questions.
• In addition to the foregoing assessment, list two additional laboratory and diagnostic tests that are routinely drawn and performed when a laboring woman is admitted to the Labor and Delivery unit.

Case Study Continued:

Since you are monitoring fetal heart tones in the upper left quadrant of L.G.’s abdomen, you suspect that the fetus is mal-positioned. A quick ultrasound scan confirms that the fetal head is not vertex in the mother’s pelvis. Further, L.G.’s amniotic membranes ruptured spontaneously during a uterine contraction, the fetal heart rate dropped from its baseline of 130-140 bpm to 90 bpm and you immediately see that the fetus’s umbilical cord has prolapsed.

Answer the following questions:

• What initial nursing interventions would you perform to improve maternal and fetal outcomes given the prolapsed cord?
• Why is a prolapsed cord an obstetrical emergency?
• Given the obstetrical emergency, what is the safest method of L.G.’s fetus and why?