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Umbilical cord prolapse and the benefits of high quality training

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    Kerstin Kubiak considers the role of simulation training in managing umbilical cord prolapse, which is an obstetric emergency during labour.

    By Kerstin Kubiak

Umbilical cord prolapse occurs when the umbilical cord or part of the cord presents or delivers before the baby during labour. Although this is a rare occurrence it is an obstetric emergency as the pressure on top of the cord from the baby may block the blood circulation and oxygen supply the baby. This carries with it the risk of serious neurological injury or even death for the unborn baby and my colleague has written more about this previously.

The importance of simulation training

In these circumstances it is imperative that medical professionals are trained on how to manage this emergency of umbilical cord prolapse and undertake all steps possible to preserve the well being of the baby.

Southmead hospital in Bristol is a leading research centre for the management and importance of training in obstetric (childbirth) emergencies. They use real life mannequins as part of their standard training for obstetricians and midwives in order to enable them to be better prepared for the real event occurring. A complication in childbirth is a real fear for many expectant parents and knowing that the medical staff caring for you have had a high level of sophisticated training will give much reassurance.

Views of those who use simulated training:

Professor Tim Draycott, consultant obstetrician at Southmead Hospital in Bristol, said in the video for SimMom (the company which produces the maternal mannequins)[1]:

There seems to be common themes for error in all emergencies, particularly during pregnancy.”

There’s a failure to recognise the problem, failure to respond appropriately to that problem, and a failure to refer to the right level of medical staff.”

Therefore, providing simulation can really provide a platform to streamline our care and improve our management to get the best possible outcomes.”

Dr Sonia Barnfield, also a consultant obstetrician at Southmead, said: “Simulation is really useful because although obstetric emergencies happen, they also happen rarely, and therefore, the only way to be practiced in treating them is to actually train on a regular basis.”

National guidelines for management of umbilical cord prolapse:

Umbilical cord prolapse is a rare but life threatening condition for the baby. The Royal College of Obstetricians and Gynaecologists (RCOG) have issued national guidance (‘Umbilical Cord Prolapse’ RCOG Green-top Guideline No. 50, November 2014) for the management of this emergency. The guidance includes:

  • There are particular risk factors for prolapse to occur and women with these factors should be carefully monitored;
  • Once prolapse is diagnosed there should be an immediate call for emergency assistance and preparations made for an emergency caesarean section;
  • The mother should be placed in a position to avoid any further pressure on the umbilical cord;
  • The medics should manually relieve the pressure on the cord by pressing on the baby’s presenting part (e.g. head or body);
  • Consideration should be given for the administration of a drug to stop uterine contractions.

Our experience:

My colleagues and I have handled many medical negligence cases where midwives or doctors have failed to either diagnose or properly manage an umbilical cord prolapse. Due to the rarity of the occurrence this may be related to poor training or inadequate internal protocols for this emergency. Either way, there is no excuse for failing to respond properly to this emergency as the consequences can be serious, resulting in significant brain injury and a subsequent diagnosis of cerebral palsy. I hope that more hospitals will adopt the approach of full simulation training and the benefits this can bring in managing this emergency in real life to prevent such injuries.

[1] SimMom® Laerdal Medical

 

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