[Prolapse of umbilical cord - new aspects (author's transl)]

In an evaluation of more than 20,000 births, 39 recorded cases of prolapse of the umbilical cord were investigated in greater detail for the risk of perinatal mortality and morbidity. Particular attention was given to several variants of breech presentation in comparison to vertex presentations as well as to the time of rupture. The interval between diagnosis of prolapse of the umbilical cord and termination of birth was also in the focus of interest.-The authors concluded that the overall definition of "breech presentation" was quite inadequate and should be replaced, at least, by differentiation between real breech presentation and combined breech-footling presentations, in order to make allowance for the highly differentiated risks involved.-Therefore, a demand is made for strict differentiation of approach in key with presentation. Delivery should be terminated immediately in cases of prolapse of the umbilical cord in concomitance with real breech presentation or vertex presentation, whereas no direct time pressure existed in cases of combined breech-footling presentation.-The approach taken to all kinds of breech presentation, above all real breech presentation, should be identical with that taken to vertex presentation for adequately programmed delivery which has been a growing demand.-All conclusions proposed are discussed in great detail and substantiated as well as supported by comprehensive literature data.