Evaluation of risk factor and complication of umbilical cord prolapsed in cesarean section

Document Type : Original Article

Authors

1 Tehran University of medical sciences

2 Maternal- fetal & Neonatal Research Center, Tehran University of medical sciences

3 Tehran University of Medical Sciences

4 Breastfeeding Research Center, Tehran University of medical sciences

5 Obstetrics & Gynecology Department, School of Medicine, Tehran university of Medical Sciences, Tehran, Iran

6 Department of Physiology, McGill University, Canada

Abstract

Objectives: Considering the rarity of umbilical cord prolapse (UCP) and lack of accurate data about the risk factors and health outcomes, we aimed to evaluate cases of cesarean section (CS) due to UCP in order to reduce treatment costs and provide information about the mortality and morbidity associated with this condition.
Patients & Methods: Of 35,259 cases of CS performed in four hospitals during 2004-2012, 103 cases of UCP were selected as the case group; on the other hand, 318 cases without UCP were classified as the control group. Information was extracted from patients' records and analyzed by SPSS version 18.
Results: Prevalence of UCP was estimated at 0.2%. In the case group, the active phase of labor was reported 1.4 times (81% vs 57%-P<0.00), engagement 8 times (14% vs 2% -P<0.001), transverse presentation 8 times (6% vs 2%-P<0.002), grand multiparity 3.9 times (4% vs 0-P<0.001), oligohydramnios 4.7 times (5% vs. 0-P<0.0001, and polyhydramnios 5.9 times (6% vs 0 - P<0.001). UCP was more prevalent in post-term deliveries (P<0.043). One-minute Apgar score < 7 was 3 times more prevalent in neonates of the case group (P<0.00). Prepartum vaginal bleeding was 4 times more common in the case group, compared to the control group; also, decreased fetal movement and heart rate drop were more prevalent in the case group. Mortality rate was 5.2% in the case group and 1.7% in the control group. Overall, the control group had a better general health at discharge, compared to the case group.
Conclusion: A statistically significant correlation was detected between UCP and gestational age, active phase of labor, fetal presentation, engagement, parity, and amniotic fluid volume.

Keywords


  1. 1.     DeCherney AH, Nathan L, Laufer N, Roman AS. Current diagnosis & treatement obstetrics 7 gynecology. 11th ed. New York: McGraw-Hill Medical; 2012. Chapter 19, Malpresentation & Cord Prolapse; p.355-59.

    1. Calder AA. Emergencies in operative obstetrics. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000; 14(1):43-55.
    2. Usta IM, Mercer BM, SibaiBM .Current obstetrical practice and umbilical cord prolapse. Am J Perinatol. 1999; 16(9):479-84.
    3. Dilbaz B, Ozturkoglu E, Dilbaz S, Ozturk N, Sivaslioglu AA, Haberal A. Risk factors and perinatal outcomes associated with umbilical cord prolapse. Arch Gynecol Obstet. 2006; 274(2):104-7.
    4. Poetker DM, Rijhsinghani A. Fetal survival after umbilical cord prolapse for more than three days. A case report. J Reprod Med. 2001; 46(8):776-8.
    5. Bozhinova S, Porozhanova V, Popovski K. The significance of the problem of umbilical cord prolapse during delivery. Akush Ginekol. 1998; 37(1):10-2.
    6. James DK, Steer PJ, Weiner CP,  Gonik B. High risk obstetrics management options. 4th ed.Philadelphia: Saunders; 1994.
    7. Gabbe SG, Niebyl JR, Simpson JL.Obstetrics – Normal & Problem Pregnancies. 6th ed. Philadelphia: Saunders; 2012.
    8. Uygur D, Kiş S, Tuncer R, Ozcan FS, Erkaya S. Risk factors and infant outcomes associated with umbilical cord prolapse. Int J Gynaecol Obstet. 2002; 78(2):127-30.

    10. Alouini S, Mesnard L, Megier P, Lemaire B, Coly S, DesrochesA.Management of umbilical cord prolapse and neonatal outcomes. J Gynecol Obstet Biol Reprod (Paris). 2010; 39(6):471-7.

    11. Dare FO, Owolabi AT, Fasubaa OB, Ezechi OC. Umbilical cord prolapse: a clinical study of 60 cases seen at ObafemiAwolowo University Teaching Hospital, Ile-Ife.East Afr Med J. 1998; 75(5):308-10.

    12. Obeidat N, Zayed F, Alchalabi H, Obeidat B, El-Jallad MF, ObeidatM. Umbilical cord prolapse: a 10-year retrospective study in two civil hospitals, North Jordan. J Obstet Gynaecol. 2010; 30(3):257-60.

    13. Boyle JJ, Katz VL. Umbilical cord prolapses in current obstetric practice. J Reprod Med. 2005; 50(5):303-6.

    14. Bako B, Chama C, Audu BM. Emergency obstetrics care in a Nigerian tertiary hospital: a 20 year review of umblical cord prolapse. Niger J ClinPract. 2009; 12(3):232-6.

    15. Tan WC, Tan LK, Tan HK, Tan AS.  Audit of 'crash' emergency caesarean sections due to cord prolapse in terms of response time and perinatal outcome. Ann Acad Med Singapore. 2003; 32(5):638-41.

    16. Kahana B, Sheiner E, Levy A, Lazer S, Mazor M. Umbilical cord prolapse and perinatal outcomes. Int J Gynaecol Obstet. 2004; 84(2):127-32

    17. Khan RS, Naru T, Nizami F. Umbilical cord prolapse--a review of diagnosis to delivery interval on perinatal and maternal outcome. J Pak Med Assoc. 2007; 57(10):487-91.

    18. Murphy DJ, MacKenzie IZ. The mortality and morbidity associated with umbilical cord prolapse. Br J ObstetGynaecol. 1995; 102(10):826-30.

     

    19. Faiz SA, Habib FA, Sporrong BG, Khalil NA. Results of delivery in umbilical cord prolapse. Saudi Med J. 2003; 24(7):754-7.