FHM Vignette #16: Umbilical Cord Prolapse

Course overview

Training on reading FHR monitor strips is often not applied to specific clinical situations or to an understanding of why the FHR patterns look as they do in those situations. This activity reviews FHR patterns and highlights useful information for practitioners who interpret fetal tracings. The basic steps in FHR monitor strip interpretation include: 1) accurate assessment of the FHR pattern using the standardized NICHD terminology; 2) accurate assessment of maternal uterine activity; 3) consideration of maternal/fetal physiology as it relates to the current clinical situation; 4) determination of the appropriate FHR category; and 5) intervention and management appropriate to tracing interpretation. In this activity, we will cover amniotic fluid measurement and we will look at causes and treatments for hydramnios (polyhydramnios) including a review of Indomethacin dosing. We will also examine types of cord prolapse, management of cord prolapse and FHR patterns associated with cord prolapse. After completing this activity, practitioners should be able to: state the FHR pattern most likely to be associated with umbilical cord prolapse; list emergency interventions/clinical responses for umbilical cord prolapse; and recognize umbilical cord prolapse as an obstetrical emergency requiring a well-coordinated team response in order to provide a safe perinatal outcome.