Umbilical cord prolapse--a review of diagnosis to delivery interval on perinatal and maternal outcome.

OBJECTIVE To determine the significance of the Diagnosis to Delivery Interval (DDI) on perinatal outcome and maternal complications in patients with umbilical cord prolapse. METHODS This was a case series of 44 patients identified with "Umbilical cord prolapse" during a 10-year period at the Aga Khan University Hospital. Data was retrieved for gestational age, foetal presentation, DDI, incision to delivery time, delivery method, apgar score, birth weight and outcome, and maternal complications. The influence of DDI on perinatal mortality, apgar scores at 5 minutes, neonatal intensive care unit (NICU) admission and maternal complications resulting from mode of delivery with cord prolapse was assessed. RESULTS The hospital based incidence of cord prolapse was 1.4 per 1000 deliveries. The mean DDI was 18 minutes, with 64% of women delivering within this time. Of the 13 (29%) neonates transferred to NICU with < 7 apgar score at 5 minutes, 10/13 (76%) delivered within the mean DDI. There were 4 perinatal deaths, of which 2 were term pregnancies with birth asphyxia, whereas 2 were < or = 28 weeks. There was no statistically significant impact of DDI on 5-minute apgar scores, perinatal mortality, NICU admissions and maternal complications in patients with cord prolapse CONCLUSIONS DDI may not be the only critical determinant of neonatal outcome. Most neonates with poor apgar scores had DDI within the average time. Artificial rupture of membranes should be performed cautiously with preexisting CTG trace abnormalities. In-utero resuscitative measures may help reduce further cord compression and improve outcome.