Prolapse and Presentation of the Umbilical Cord

Abstract

The outcome of pregnancies with prolapse and presentation of the umbilical cord at Tsan Yuk Hospital, Hong Kong, 1976 to 1982, was reviewed. The incidence was 0.17%, 70 of 41,939 deliveries; 98% of cases were diagnosed in hospital. Breech presentation, low birth-weight and artificial rupture of membranes were found to be significant associations; 78% of cases were discovered by vaginal examination and the diagnosis-delivery interval was less than 30 minutes in 75%. There were 8 perinatal deaths and 3 of these occurred in babies whose birth-weights were less than 1,000 g; 2 stillbirths were associated with presentation of the cord. The corrected perinatal mortality was 8.6% with a corresponding Caesarean section rate of 73.3%. 80% of the babies born by Caesarean section had 5 minutes Apgar scores of 7 or more. It was concluded that early diagnosis of umbilical cord prolapse followed by prompt treatment are effective in reducing the perinatal mortality rate. Energetic intrapartum monitoring is also essential in order that patients with occult prolapse or presentation of the umbilical cord be diagnosed early and treated promptly.

Outcomes by planned place of birth: Implications of the Birthplace Study

“…In this case study it was the latter. The overall incidence of cord prolapse is between 0.1-0.6% (Woo et al, 1983). Delay in transfer appears to be the major contributing factor in perinatal death (Murphy and MacKensie, 1995) in this scenario as there was an hour delay before transfer to the hospital.…”

Procidence du cordon : prise en charge obstétricale et conséquences néonatales

“…La rapidité de l'extraction foetale est reconnue comme pouvant diminuer le temps d'exposition du foetus à une souffrance foetale aiguë [15]. Pour Siassakos et al [16], la diminution du TDN de 20 à 14 min après entraînement des équipes était associée à une amélioration du management des procidences.…”

“…Le pH moyen pour ces 17 cas était de 7,07 ± 0,09 et le temps moyen diagnostic-naissance était de 13 ± 4 min (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Il y avait quatre naissances par voie basse expliquant un TDN plus court que pour l'ensemble des patientes.…”

Fetal survival after conservative management of cord prolapse for three weeks

“…Predisposing factors include low birthweight, fetal malpresentation, multiparity, premature rupture of membranes, multiple gestation and obstetric manipulation. All can result in inadequate filling of the maternal pelvis with the fetal presenting part 1–3 . Prompt delivery is usually required for fetal survival, often by emergency caesarean section unless, vaginal birth is imminent.…”