Unexpected Survival After Conservative Management of Cord Prolapse in Two Very Preterm Babies

Abstract

Two very preterm infants (24 and 25 weeks) were born vaginally in spite of prolapse of the umbilical cord. The prolapses lasted 45 min and 2 h, respectively, but though both babies were at first believed to be lost, they survived, only mild to moderate asphyxia, and both were discharged well. One of the babies later developed slight neurological sequelae. Even a very preterm baby has the possibility of surviving vaginal delivery complicated by cord prolapse.

Fetal survival after conservative management of cord prolapse for three weeks

“…These manoeuvres were not attempted in our case. The extreme prematurity and low birthweight may have resulted in less cord compression, minimising asphyxia and improving fetal outcome, as has been suggested in previous reports 8 . Despite the potential risk of cord spasm, in our patient, digital replacement of the cord following prolapse outside of the vagina appeared to have no immediate adverse effects on the cord or the fetus.…”

“…The extreme prematurity and low birthweight may have resulted in less cord compression, minimising asphyxia and improving fetal outcome, as has been suggested in previous reports. 8 Despite the potential risk of cord spasm, in our patient, digital replacement of the cord following prolapse outside of the vagina appeared to have no immediate adverse effects on the cord or the fetus. In our situation, avoidance of cardiotocography was deliberate as variable fetal heart rate decelerations or bradycardia at this early gestation might prompt unwarranted early delivery.…”