Perinatal death associated with umbilical cord prolapse

Mark P. Hehir; Lucia Hartigan; Rhona Mahony

doi:10.1515/jpm-2016-0223

Article

Perinatal death associated with umbilical cord prolapse

Mark P. Hehir , Lucia Hartigan and Rhona Mahony

Published/Copyright: November 10, 2016

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From the journal Journal of Perinatal Medicine Volume 45 Issue 5

Abstract

Objective:

Umbilical cord prolapse occurs when the cord prolapses ahead of or alongside the presenting part. It is an acute obstetric emergency with potential catastrophic effects. We set out to assess incidence of cord prolapse, as well as rates and characteristics of perinatal death associated with the condition.

Study design:

This was a retrospective cohort study. All recorded cases of cord prolapse were included, and rates of perinatal death and encephalopathy, as well as intrapartum and maternal characteristics were examined.

Results:

There were 156,130 deliveries at the hospital over the 20-year study period. Three hundred and seven cases of cord prolapse were identified (1.9/1000 deliveries). There was a decrease in the incidence of cord prolapse over the course of the study. The rate peaked in 1999 at 3.9/1000 and was just 0.8/1000 of all deliveries in 2007. The majority of cases (216/307, 70%) occurred in multiparas; however, nulliparous parturients were more likely to have a perinatal death [12% (11/91) vs. 4.6% (10/216)]. The rate of perinatal death in cases of cord prolapse was 6.8% (21/307). Over half of perinatal deaths (11/21) occurred in infants of mothers who presented with ruptured membranes, seven of these infants were already dead on reaching hospital. There was just one case of neonatal encephalopathy associated with cord prolapse, giving an incidence of 0.32%.

Conclusion:

Cord prolapse carries a significant risk of perinatal death, approximately 7%. The corresponding rate of encephalopathy is low. A significant number of deaths were diagnosed on presentation to hospital and were not deemed preventable.

Keywords: Cord prolapse; death; perinatal mortality

References

[1] Holbrook BD, Phelan ST. Umbilical cord prolapse. Obstet Gynecol Clin North Am. 2013;40:1–14.10.1016/j.ogc.2012.11.002Search in Google Scholar

[2] Gabbay-Benziv R, Maman M, Wiznitzer A, Linder N, Yogev Y. Umbilical cord prolapse during delivery – risk factors and pregnancy outcome: A single center experience. J Matern Fetal Neonatal Med. 2014;27:14–7.10.3109/14767058.2013.799651Search in Google Scholar

[3] Kahana B, Sheiner E, Levy A, Levy A, Lazer S, Mazor M. Umbilical cord prolapse and perinatal outcomes. Int J Gynaecol Obstet. 2004;84:127–32.10.1016/S0020-7292(03)00333-3Search in Google Scholar

[4] Murphy DJ, MacKenzie IZ. The mortality and morbidity associated with umbilical cord prolapse. Br J Obstet Gynaecol. 1995;102:826–30.10.1111/j.1471-0528.1995.tb10850.xSearch in Google Scholar

[5] Gibbons C, O’Herlihy C, Murphy JF. Umbilical cord prolapse–changing patterns and improved outcomes: a retrospective cohort study. Br J Obstet Gynaecol. 2014;121:1705–8.10.1111/1471-0528.12890Search in Google Scholar

[6] Lin MG. Umbilical cord prolapse. Obstet Gynecol Surv. 2006;61:269–77.10.1097/01.ogx.0000208802.20908.c6Search in Google Scholar

[7] Yla-Outinen A, Heinonen PK, Tuimala R. Predisposing and risk factors of umbilical cord prolapse. Acta Obstet Gynecol Scand. 1985;64:567–70.10.3109/00016348509156364Search in Google Scholar

[8] Koonings PP, Paul RH, Campbell K. Umbilical cord prolapse: a contemporary look. J Reprod Med. 1990;35:690–2.Search in Google Scholar

[9] Usta IM, Mercer BM, Sibai BM. Current obstetrical practice and umbilical cord prolapse. Am J Perinatol. 1999;16:479–84.10.1055/s-1999-6809Search in Google Scholar

[10] Yamada T, Kataoka S, Takeda M, Kojima T, Yamada T, Morikawa M, et al. Umbilical cord presentation after use of a trans-cervical balloon catheter. J Obstet Gynaecol Res. 2013;39:658–62.10.1111/j.1447-0756.2012.02008.xSearch in Google Scholar

[11] Berghella V. Prolapsed cord after external cephalic version in a patient with premature rupture of membranes and transverse lie. Eur J Obstet Gynecol Reprod Biol. 2001;99:274–5.10.1016/S0301-2115(01)00389-XSearch in Google Scholar

[12] Hehir MP, Higgins S. The changing patient population at one of Europe’s busiest maternity units. Int J Gynaecol Obstet. 2012;118:252–3.10.1016/j.ijgo.2012.04.006Search in Google Scholar

[13] Walsh J, Mahony R, Armstrong F, Ryan G, O’Herlihy C, Foley M. Ethnic variation between white European women in labour outcomes in a setting in which the management of labour is standardised-a healthy migrant effect? Br J Obstet Gynaecol. 2011;118:713–8.10.1111/j.1471-0528.2010.02878.xSearch in Google Scholar

[14] Hehir MP, Walsh JM, Higgins S, Mahony R. Maternal and neonatal morbidity during off peak hours in a busy obstetric unit. Are deliveries after midnight more complicated? Acta Obstet Gynecol Scand. 2014;93:189–93.10.1111/aogs.12307Search in Google Scholar

[15] Hehir MP, Fitzpatrick M, Cassidy M, Murphy M, O’Herlihy C. Are women having a vaginal birth after a previous caesarean delivery at increased risk of anal sphincter injury? Br J Obstet Gynaecol. 2014;121:1515–20.10.1111/1471-0528.12706Search in Google Scholar

[16] Hehir MP, O’Connor HD, Kent EM, Fitzpatrick C, Boylan PC, Coulter-Smith S, et al. Changes in vaginal breech delivery rates in a single large metropolitan area. Am J Obstet Gynecol. 2012;206:498.e1–4.10.1016/j.ajog.2012.03.029Search in Google Scholar

[17] Hehir MP. Trends in vaginal breech delivery. J Epidemiol Community Health. 2015;69:1237–9.10.1136/jech-2015-205592Search in Google Scholar

[18] Brennan DJ, Murphy M, Robson MS, O’Herlihy C. The singleton, cephalic, nulliparous woman after 36 weeks of gestation: contribution to overall cesarean delivery rates. Obstet Gynecol. 2011;117(2 Pt 1):273–9.10.1097/AOG.0b013e318204521aSearch in Google Scholar

[19] Hehir MP, Reidy FR, Wilkinson MN, Mahony R. Increasing rates of operative vaginal delivery across two decades: accompanying outcomes and instrument preferences. Eur J Obstet Gynecol Reprod Biol. 2013;171:40–3.10.1016/j.ejogrb.2013.08.015Search in Google Scholar

[20] Siassakos D, Hasafa Z, Sibanda T, Fox R, Donald F, Winter C, et al. Retrospective cohort study of diagnosis-delivery interval with umbilical cord prolapse: the effect of team training. Br J Obstet Gynaecol. 2009;116:1089–96.10.1111/j.1471-0528.2009.02179.xSearch in Google Scholar

[21] Critchlow CW, Leet TL, Benedetti TJ, Daling JR. Risk factors and infant outcomes associated with umbilical cord prolapse: a population-based case-control study among births in Washington State. Am J Obstet Gynecol. 1994;170:613–8.10.1016/S0002-9378(94)70238-1Search in Google Scholar

[22] Huang JP, Chen CP, Chen CP, Wang KG, Wang KL. Term pregnancy with umbilical cord prolapse. Taiwan J Obstet Gynecol. 2012;51:375–80.10.1016/j.tjog.2012.07.010Search in Google Scholar PubMed

[23] Erdemoglu M, Kale A, Kuyumcuoglu U, Akdeniz N, Güzel AI. Umbilical cord prolapse in the southeast region of Turkey: evaluation of 79 cases. Clin Exp Obstet Gynecol. 2010;37:141–3.Search in Google Scholar

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2016-7-5

Accepted: 2016-10-6

Published Online: 2016-11-10

Published in Print: 2017-7-26

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Articles in the same Issue

https://doi.org/10.1515/jpm-2016-0223

Keywords for this article

Cord prolapse; death; perinatal mortality