Maternal Risk Factors and Outcomes of Umbilical Cord Prolapse: A Population-Based Study

Umbilical cord prolapse (UCP) is a rare event believed to be associated with adverse outcomes. The purpose of our study was to use a large administrative database to better identify incidence, predictors, and outcomes of births with UCP.

We carried out a retrospective cohort study using data from the National Center for Health Statistics- Linked Birth Infant Death and Fetal Death (United States) data files during the years 2003-2005. The incidence, predictors, and outcomes of births with UCP were compared to births with no UCP. Logistic regression analysis was performed to estimate the adjusted effect of UCP on maternal and neonatal outcomes.

There were 16 126 cases of UCP among 10 040 416 births, for an incidence of 16.1 cases per 10 000 births. While most cases occurred at term and in women with one or two previous births, early gestational age, grand multiparity, prolonged labour, and malpresentation were the strongest risk factors. UCP was associated with an increased risk of placental abruption, excessive bleeding, Caesarean sections, lower Apgar scores, requiring assisted ventilation, neonatal seizures, hyaline membrane disease, and fetal injuries. Deliveries by Caesarean section were associated with a greater risk of fetal injuries than vaginal delivery (18.5% vs 8.7%; OR 2.6, 95% CI 2.3 to 2.9, P < 0.001).

Although there are established risk factors, UCP occurs most commonly in low risk women at term. When possible, vaginal delivery is preferred in women with UCP because it appears to be associated with a lower risk of fetal injury.