Medline ® Abstracts for References 1,2

AIM: To determine the incidence of umbilical cord prolapse, the characteristics of the population, and to evaluate its management and the neonatal prognosis.

MATERIAL AND METHODS: Ninety-three cases of cord prolapse that occurred between January 1986 and December 2009 at our level III labour ward were studied retrospectively.

RESULTS: The incidence of cord prolapse was 0.18%. It occurred in 66.7% of cases in multiparous patients, in 19.4% of cases in twin pregnancies, and in 41.9% of cases in breech presentations. In 34.4% of cases, the gestational age was less than 37 weeks. Birth occurred vaginally in 33.3% of cases with a delivery time interval significantly less than for caesarean sections (P<0.001). At complete cervical dilation, more than three quarter of patients delivered vaginally. Vaginal birth was significantly more frequent in case of breech (P=0.009) and second twin (P=0.03). Parity did not influence birth route. Neonates with a birth weight less than 2500 g (30.1%) had significantly more frequently an Apgar score less than 7 at 5 min (P=0.02), a higher rate oftransfer to intensive care (P<0.001) and a longer hospital stay (P=0.002). We report six neonatal deaths (6.5%). Neonatal status was not influenced by the time interval for delivery.

CONCLUSION: Umbilical cord prolapse is still nowadays a serious complication of pregnancy, responsible for a significant rate of neonatal mortality. The aim in case of cord prolapse is to obtain fetal delivery the quickest way possible so as to improve the neonatal outcome. In some particular obstetrical situations such as breech presentations and second twin deliveries, birth occurs faster if performed vaginally as shown by our case study.

OBJECTIVE: Umbilical cord prolapse is an acute obstetrical emergency requiring rapid identification and intervention. Its management has undergone significant changes over the past century. This study aims to document the changes in incidence, morbidity, and perinatal mortality over a 69-year period.

DESIGN: A retrospective review of the annual clinical reports of the National Maternity Hospital, Dublin, Ireland, was performed.

SETTING: The National Maternity hospital was founded in 1894 and has nearly 10,000 deliveries each year.

POPULATION: All deliveries in the hospital for each year are included in each annual report.

METHODS: We reviewed the reports from a 69-year period (1940-2009). Information from the reports was collated into a database and analysed using Microsoft excel 2007.

MAIN OUTCOME MEASURES: Incidence and outcome of all cases of umbilical cord prolapse were recorded, along with the neurological outcome of all neonatal survivors (available since 1970).

RESULTS: The incidence of cord prolapse has decreased from 6.4/1000 live births in the 1940s to 1.7/1000 [corrected]live births in the last decade. Perinatal survival increased from 46 to 94% in the same period of time. This is inversely related to the use of caesarean section as the recommended method of delivery in this emergency. Short- and long-term neurological impairment remains rare.

CONCLUSIONS: There has been a large reduction in the incidence of cord prolapse over a period of 69 years. A reduction in grand multiparity and use of caesarean section as the gold standard for delivery are likely to have accounted for the changes seen. Neurological impairment remains unusual.