Umbilical cord prolapse. Is the time from diagnosis to delivery critical?

To review the peripartum clinical course of patients whose pregnancies are complicated by umbilical cord prolapse at a large teaching hospital and to evaluate the time from diagnosis to delivery and its impact on neonatal outcome.

The computerized perinatal database at Hartford Hospital was used to identify all cases of umbilical cord prolapse from 1988 to 1994. Each maternal and neonatal chart was reviewed, and the following variables were evaluated: gestational age, fetal presentation, status of membranes, time from diagnosis to delivery, mode of delivery, type of anesthesia and neonatal outcome.

A total of 65 cases of umbilical cord prolapse were identified from 26,545 deliveries. There were 48 cases of frank cord prolapse and 17 of occult prolapse. Cord prolapse occurred with artificial rupture of membranes in 51% of cases and in 74% of patients at term. There were 59 cesarean births and 6 vaginal deliveries (5 in the occult prolapse group). The mean time from diagnosis to delivery was 20 minutes (range, 2-77). None of the neonates with an occult cord prolapse had a five-minute Apgar score < 7, while 9 (19%) of the neonates with frank prolapse had a five-minute Apgar score < 7. In the frank prolapse group, there were five cases of neonatal asphyxia, all at a gestational age of > or = 36 weeks, and all were delivered by cesarean section. The mean delivery time for these affected neonates was 11 minutes (range, 5-16).

Our review indicated that umbilical cord prolapse continues to be associated with poor perinatal outcomes in some cases despite emergency delivery in a modern, high-risk obstetric unit. The asphyxiated neonate had a shorter-than-average time from diagnosis to delivery, suggesting that the time from diagnosis to delivery may not be the only critical determinant of neonatal outcome, particularly with frank cord prolapse. Occult cord prolapse was associated with less perinatal morbidity when compared to frank prolapse.