Prolapse of the Umbilical Cord: Results of Deliveries

Short Communications


Yousef GadmourĀ¹, Gennady A. SilinĀ²

1-Department of Obstetrics and Gynaecology, Faculty of Medicine, Al-Fateh University, Tripoli 2-Gharian Central Hospital, Gharian, Libya

JMJ 2007,Vol.7, No.4:292-294


Objective: To review the peripartum clinical course of patients whose pregnancies were complicated by umbilical cord prolapse and to evaluate its impact on neonatal outcome. Setting: Gharian Central Hospital, Gharian, Libya. Subjects: 88 cases of umbilical cord prolapse among 45375 deliveries from period 1992 to 2003. Design: We analyzed all cases of umbilical cord prolapse in Gharian Central Hospital from January1992 to Dec 2003. There were 88 cases complicated with umbilical cord prolapse among 45375 deliveries. Each maternal and neonatal chart was reviewed to evaluate the following: maternal age, parity, and gestational age, and foetal presentation, mode of delivery, diagnosis delivery time and neonatal outcome. Results: The incidence of umbilical cord prolapse was 1 in 518 total births (1.93:1000). The incidence was different according to the gestational age. Cord prolapse occurred in 72.7% of the patients at term, 23.9% at pre-term and 3.4% at post term. Regarding foetal presentation, 76.1% of cases were vertex, 11.4% were breech, and 10.2% were transverse presentation. Among all cases of cord prolapse 95.5% of foetuses were singleton and 4.5% were twins. At the time of diagnosis; 69.3% of the cases the amniotic membranes were ruptured spontaneously, 6.8% were intact, and in 23.9% of amniotomy was done. Regarding the mode of delivery; 94.3% of cases were delivered by caesarean section and 5.7% of cases had normal vaginal delivery. The mean diagnosis delivery time was 30 min (range: 5- 85 min). 5.7% of the cases were delivered in <15 min interval, 55.7% and 38.6% of them were born in 15-30 min and >30 min intervals respectively. Concerning the neonatal outcome; 5 minute Apgar Score was less than 7 in 10.2% of the neonates. The Apgar Scores at 5-min were 6.2, 8.4 and 8.6 with diagnosis delivery time <15min, 15-30 min and >30 min respectively (P- value <0,001). There were four (4.5 %) asphyxiated neonates. There was no major neurological handicap in the survivors. There were only two neonatal deaths. The uncorrected peri-natal mortality rate was 22.7 per 1000. Conclusion: Perinatal mortality in this study is attributable to congenital anomalies and prematurity rather than birth asphyxia. The asphyxiated neonates had a shorter than average diagnosis-delivery time, and were mostly delivered vaginally. Our study supports clinical management of umbilical cord prolapse by caesarean section. However statically significant higher Apgar scores were found with caesarean section delivery in >30 min diagnosis- delivery time. So this diagnosis delivery time may not be the only determinant of neonatal outcome.

Keywords: Prolapse of umbilical cord, Clinical course, Neonatal outcome