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Current obstetrical practice and umbilical cord prolapse.

I M Usta1, B M Mercer, B M Sibai

  • 1Department of Obstetrics & Gynecology, University of Tennessee, Memphis, USA.

American Journal of Perinatology
|April 25, 2000
PubMed
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Obstetrical interventions contribute to nearly half of umbilical cord prolapse cases. However, these interventions do not worsen perinatal complications or mortality in affected infants.

Area of Science:

  • Obstetrics and Gynecology
  • Neonatal Medicine
  • Perinatology

Background:

  • Umbilical cord prolapse (UCP) is a significant obstetric emergency.
  • Understanding the role of obstetrical interventions in UCP is crucial for improving outcomes.

Purpose of the Study:

  • To evaluate how current obstetrical practices contribute to the incidence and complications of umbilical cord prolapse.
  • To compare perinatal morbidity and mortality between UCP cases with and without preceding obstetrical interventions.

Main Methods:

  • Retrospective review of maternal and neonatal charts for 87 pregnancies with true umbilical cord prolapse over a 5-year period.
  • Categorization of cases into 'obstetrical intervention' and 'no-intervention' groups.
  • Analysis of delivery methods, gestational age, birth weight, Apgar scores, cord pH, and neonatal outcomes.

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Main Results:

  • Obstetrical interventions preceded 47% of UCP cases, including amniotomy, fetal monitoring device application, and external cephalic version.
  • Twin gestation and noncephalic presentations were common (14% and 41%).
  • Infants delivered via cesarean section (89%) had a mean gestational age of 34 weeks.
  • Perinatal outcomes, including mortality, Apgar scores, and specific neonatal morbidities, were similar between the intervention and no-intervention groups, with most complications occurring in infants < 32 weeks gestation.

Conclusions:

  • Nearly half of umbilical cord prolapse cases are associated with prior obstetrical interventions.
  • Despite contributing to UCP occurrence, these interventions do not appear to increase the risk of perinatal morbidity or mortality.
  • Neonatal complications are primarily linked to prematurity (< 32 weeks gestation).