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NOTE: If the placenta has not been delivered by 30 mins of the baby arriving it is classed as the placenta being in retention. Cord Prolapse: when the umbilical cord precedes the fetus' exit from the uterus it is said to be 'prolapsed' Although the baby does not have to be visible from the entrance of the vagina. It is an obstetric emergency during pregnancy or labour that imminently endangers the life of the fetus. Shoulder dystocia: after the delivery of the head, the anterior shoulder of the baby cannot pass below the pubic bone. During delivery it is said the baby shows the 'turtle neck sign', which involves the appearance and retraction of the fetal head as the chin presses against the walls of the perineum. Breech Presentation: In the breech presentation the baby enters the birth canal with the buttocks or feet first as opposed to the normal head down presentation.

There are 3 common breech presentations: Frank 65% - Bottom first with legs flexed at hips and legs extended from the knees.
Ideally having the patient in a head down on her knees with them pulled into her chest is great.
When you have the patient next to the trolley get her to lay on her left side (avoid her sitting on her bottom as this may further complicate cord compression). Once the cord is presenting outside of the vagina it is susceptible to the cooling and drying effects of the outside world and thus provoking spasm which will ultimately cut off blood flow. Depending on which literature you read or your own trust protocols, it is also said that once the cord has been inserted into the vagina then the attendant should keep their fingers inserted in the vagina until the patient has been taken to the appropriate obstetric facility. Again incidences are low at around 3-4% in woman who are 'Term' however 1 in 5 pregnancies are breech at 28 weeks gestation.

This position allows gravity to act on the foetus and prevents further possible compression of the cord. Once in a left lateral position you'll need to raise her hips with blankets or lifting the foot end of the trolley. So with only one attempt (keep handling to a minimum) the cord needs to be replaced into the vagina using two fingers.
If this is successful apply a dry pad to the entrance of the vagina to reduce the risk of another prolapse.

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