Umbilical cord prolapse: A 10-year retrospective study in two civil hospitals, North Jordan

Umbilical Cord Prolapse: A Review of the Literature

Importance

Umbilical cord prolapse is a rare occurrence and is a life-threatening emergency for the fetus. These events are unpredictable and unpreventable. Umbilical cord prolapse requires swift diagnosis and management for optimal outcome.

Objective

The aim of this review is to describe the incidence, risk factor, pathophysiology, diagnosis, and management of this rare but potentially life-threatening event.

Evidence Acquisition

A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched.

Results

There were 200 articles identified, with 53 being the basis of review. Multiple risk factors for a umbilical cord prolapse have been suggested including fetal malpresentation or abnormal lie, prematurity, multifetal gestation, and polyhydramnios. The diagnosis is largely made by examination and found after rupture of membranes, and most often, examination is prompted by fetal heart rate decelerations. The management of umbilical cord prolapse is expedited delivery; however, there are rare specific scenarios in which immediate delivery is not possible and efforts should be made to relieve cord compression.

Conclusions

Rapid identification of an umbilical cord prolapse facilitates management and increases likelihood of an optimal outcome. The management is an expedited delivery with efforts to relieve cord compression until delivery can be achieved.

Relevance

Umbilical cord prolapse is a rare but a life-threatening obstetrical emergency.

Labor induction by transcervical balloon catheter and cerebral palsy associated with umbilical cord prolapse

AIM

The aim of this study was to determine whether the use of transcervical balloon catheter (TCBC) for induction of labor (IOL) is a risk factor for cerebral palsy (CP) associated with umbilical cord prolapse (UCP-CP) in singleton pregnancies with cephalic presentation.

MATERIAL AND METHODS

Among all 102 infants with CP who were preliminarily determined as caused by antenatal and/or intrapartum hypoxemia by the Japan Council for Quality Health Care until April 2012, all 56 infants who met all of the following criteria were studied: cephalic singleton pregnancy, reassuring fetal status on electronic cardiotocogram at time of admission to obstetric facilities for labor pains, ruptured fetal membranes, and/or IOL, and hypoxic-ischemic encephalopathy at birth. Clinical backgrounds were compared between six infants with UCP-CP and the remaining 50 infants with CP not associated with UCP (non-UCP-CP).

RESULTS

Frequencies of IOL (83% [5/6] vs 32% [16/50], P = 0.0236), use of TCBC (67% [4/6] vs 10% [5/50], P = 0.0044), and amniotomy (67% [4/6] vs 24% [12/50], P = 0.0494) were significantly higher in the UCP-CP than the non-UCP-CP group. Only TCBC was a risk factor significantly associated with UCP-CP after logistic regression analysis, yielding an odds ratio of 18.0 (95% confidence interval, 2.6-124; P = 0.003). Saline volumes of 80-150 mL were used for TCBC inflation in the four UCP-CP patients.

CONCLUSION

Use of TCBC with a saline volume ≥ 80 mL was a significant risk factor for UCP-CP; however, the absolute risk of UCP-CP was estimated to be very low, approximately one in 7875 TCBC users.

Term pregnancy with umbilical cord prolapse

OBJECTIVE

To investigate the incidence, management, and perinatal and long-term outcomes of term pregnancies with umbilical cord prolapse (UCP) at Mackay Memorial Hospital, Taipei, from 1998 to 2007.

MATERIALS AND METHODS

For this retrospective study, we reviewed the charts, searched a computerized birth database, and contacted the families by telephone to acquire additional follow-up information.

RESULTS

A total of 40 cases of UCP were identified among 40,827 term deliveries, an incidence of 0.1%. Twenty-six cases (65%) were delivered by emergency cesarean section (CS). Of the neonates, 18 had an Apgar score of <7 at 1 minute, 10 of these scores being sustained at 5 minutes after birth, and three infants finally died. Eleven UCPs occurred at the vaginal delivery of a second twin, and nine with malpresentation. All of the infants who had good perinatal outcomes also had good long-term outcomes. Poor perinatal outcomes occurred in cases where there was a delayed diagnosis, or an inability to carry out an emergency CS or a prompt vaginal delivery.

CONCLUSION

Early detection of UCP and expeditious delivery are crucial to good perinatal outcomes. An emergency CS remains the mainstream management. Multiparous women whose cervixes are nearly fully dilated and who are expecting babies relatively smaller than their elder brothers or sisters born vaginally may still have vaginal deliveries managed by well-experienced birth teams, with good perinatal outcomes. Otherwise, vaginal delivery is not recommended and CS is the wiser choice.