Scenario in a Nutshell
Umbilical cord prolapse discovered in parous woman on antenatal ward. CTG suspicious. Transferred urgently to theatre with midwife elevating presenting part per vaginum.
Stage 1: Transfer to operating table and prepare for GA category 1 caesarean section.
Stage 2: Obstetric team analyse CTG and plan for category 2 caesarean section under regional anaesthesia. Spinal inserted.
Stage 3: Deterioration of CTG requiring urgent delivery.
Target Learner Groups
All members of the multidisciplinary obstetric team: anaesthetists, midwives, obstetricians, operating department practitioners/anaesthetic nurses and theatre scrub teams.
| Specific learning opportunities |
|---|
| Effective team management of obstetric emergency – umbilical cord prolapse |
| Demonstrate effective communication and decision-making, particularly around method of anaesthesia and delivery |
| Suggested learners (to represent their normal roles) | In the theatre from the start | Available when requested |
|---|---|---|
| Anaesthetic ST3+ | √ | |
| Obstetric ST3+ | √ | |
| Midwife Coordinator | √ | |
| Midwife taking over care from ward midwife | √ | |
| Theatre team – Operating Department Practitioner (ODP)/anaesthetic nurse | √ | |
| Theatre team – scrub nurse | √ | |
| Theatre team – runner | √ | |
| Obstetric consultant | √ | |
| Anaesthetic consultant | √ | |
| Suggested facilitators | ||
| Faculty to play role of midwife transferring patient from ward to theatre | √ | |
| Faculty to play role of patient’s partner | √ |
Details for Facilitators
Patient Demographics
Name: Lucy Age: 34 Gestation: 34+4 Booking weight: 65 kg Parity: P2 |
Scenario Summary
34-year-old para 2, on antenatal ward for threatened preterm labour, 34 weeks gestation.
CTG commenced on antenatal ward as pain increased, CTG abnormal.
Vaginal examination by obstetric registrar on antenatal ward, found to have cord prolapse, cephalic, 7 cm dilated.
Transferred directly to obstetric theatre.
Transferred on bed in knee-chest position with ward midwife maintaining elevation of presenting part vaginally.
CTG recommenced in theatre, normal.
Prepare for caesarean section as cervix 7 cm dilated on ward.
Bladder filled with normal saline to maintain elevation of presenting part.
Spinal inserted in left lateral position, CTG remains acceptable – couple of decelerations, but OK on the whole.
After spinal insertion, CTG deteriorates. Fully dilated now; therefore, proceed to instrumental delivery.
Set-up Overview for Facilitators
| Clinical setting | Obstetric theatre |
| Patient position | Wheeled in on bed in knee-chest position with midwife on bed elevating the presenting part vaginally |
| Initial monitoring in place | None initially |
| Other equipment | 16G cannula dorsum left hand |
| Useful manikin functions | Birthing manikin |
Medical Equipment
For core equipment checklist, see Chapter 9, including advanced airway equipment.
| Additional equipment specific to scenario | ||
|---|---|---|
| Equipment for instilling normal saline into bladder: 500 ml bag normal saline with either giving set or 50 ml bladder syringe and kidney dish | Local emergency checklist for umbilical cord prolapse (if available) | Induction agents (thiopentone and propofol), neuromuscular blockers (depolarising and non-depolarising) |
| Ethyl chloride spray | Theatre trolley, caesarean section tray and instrumental delivery tray | Theatre gowns/gloves |
| Spinal pack | Phenylephrine infusion | Antacids: sodium citrate, ranitidine |
Information Given to the Learners
| 11:30 a.m. on a Tuesday morning |
|
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