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American Journal of Obstetrics and... Oct 2021Umbilical cord prolapse is an unpredictable obstetrical emergency with an incidence ranging from 1 to 6 per 1000 pregnancies. It is associated with high perinatal... (Review)
Review
Umbilical cord prolapse is an unpredictable obstetrical emergency with an incidence ranging from 1 to 6 per 1000 pregnancies. It is associated with high perinatal mortality, ranging from 23% to 27% in low-income countries to 6% to 10% in high-income countries. In this review, we specifically addressed 3 issues. First, its definition is not consistent in the current literature, and "occult cord prolapse" is a misnomer because the cord is still above the cervix. We proposed that cord prolapse, cord presentation, and compound cord presentation should be classified according to the positional relationship among the cord, the fetal presenting part, and the cervix. All of them may occur with either ruptured or intact membranes. The fetal risk is highest in cord prolapse, followed by cord presentation, and lastly by compound cord presentation, which replaces the misnomer "occult cord prolapse." Second, the mainstay of treatment of cord prolapse is urgent delivery, which means cesarean delivery in most cases, unless vaginal delivery is imminent. The urgency depends on the fetal heart rate pattern, which can be bradycardia, recurrent decelerations, or normal. It is most urgent in cases with bradycardia, because a recent study showed that cord arterial pH declines significantly with the bradycardia-to-delivery interval at a rate of 0.009 per minute (95% confident interval, 0.0003-0.0180), and this may indicate an irreversible pathology such as vasospasm or persistent cord compression. However, cord arterial pH does not correlate with either deceleration-to-delivery interval or decision-to-delivery interval, indicating that intermittent cord compression causing decelerations is reversible and less risk. Third, while cesarean delivery is being arranged, different maneuvers should be adopted to relieve cord compression by elevating the fetal presenting part and to prevent further cord prolapse beyond the vagina. A recent study showed that the knee-chest position provides the greatest elevation effect, followed by filling of the maternal urinary bladder with 500 mL of fluid, and then the Trendelenburg position (15°) and other maneuvers. However, each maneuver has its own advantages and limitations; thus, they should be applied wisely and with great caution, depending on the actual clinical situation. Therefore, we have proposed an algorithm to guide this acute management.
Topics: Bradycardia; Cesarean Section; Delivery, Obstetric; Disease Management; Female; Fetal Blood; Head-Down Tilt; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Labor Presentation; Obstetric Labor Complications; Patient Positioning; Pregnancy; Prolapse; Time Factors; Tocolysis; Umbilical Cord
PubMed: 34181893
DOI: 10.1016/j.ajog.2021.06.077 -
British Medical Journal Nov 1960
Topics: Female; Humans; Pregnancy; Pregnancy Complications; Umbilical Cord
PubMed: 13749886
DOI: 10.1136/bmj.2.5211.1496 -
Obstetrics and Gynecology Clinics of... Mar 2013Umbilical cord prolapse is an obstetric emergency that can have negative outcomes for the fetus. It is diagnosed by a palpable or visible cord and is often accompanied... (Review)
Review
Umbilical cord prolapse is an obstetric emergency that can have negative outcomes for the fetus. It is diagnosed by a palpable or visible cord and is often accompanied by severe, rapid fetal heart rate decelerations. Cases of cord prolapse should be delivered as soon as possible, usually by cesarean section. While awaiting delivery, the fetal presenting part should be elevated off the cord either manually or by filling the bladder. Although an untreated case of umbilical cord prolapse can lead to severe fetal morbidity and mortality, prompt and appropriate management leads to good overall outcomes.
Topics: Apgar Score; Bradycardia; Cesarean Section; Decompression, Surgical; Delivery, Obstetric; Emergency Medicine; Female; Fetal Distress; Fetal Heart; Humans; Infant, Newborn; Intensive Care, Neonatal; Labor Presentation; North America; Obstetric Labor Complications; Obstetric Surgical Procedures; Patient Positioning; Perinatal Care; Pregnancy; Prolapse; Risk Factors; Umbilical Cord; Vagina
PubMed: 23466132
DOI: 10.1016/j.ogc.2012.11.002 -
British Medical Journal Mar 1978
Topics: Cesarean Section; Delivery, Obstetric; Female; Humans; Obstetric Labor Complications; Pregnancy; Prognosis; Prolapse; Umbilical Cord
PubMed: 630251
DOI: No ID Found -
British Medical Journal Feb 1967
Topics: Cesarean Section; Female; Hernia, Umbilical; Humans; Obstetric Labor Complications; Pregnancy
PubMed: 6018217
DOI: 10.1136/bmj.1.5538.472 -
International Journal of Women's Health 2018Umbilical cord prolapse (UCP) is an uncommon obstetric emergency that can have significant neonatal morbidity and/or mortality. It is diagnosed by seeing/palpating the... (Review)
Review
Umbilical cord prolapse (UCP) is an uncommon obstetric emergency that can have significant neonatal morbidity and/or mortality. It is diagnosed by seeing/palpating the prolapsed cord outside or within the vagina in addition to abnormal fetal heart rate patterns. Women at higher risk of UCP include multiparas with malpresentation. Other risk factors include polyhydramnios and multiple pregnancies. Iatrogenic UCP (up to 50% of cases) can occur in procedures such as amniotomy, fetal blood sampling, and insertion of a cervical ripening balloon. The perinatal outcome largely depends on the location where the prolapse occurred and the gestational age/birthweight of the fetus. When UCP is diagnosed, delivery should be expedited. Usually, cesarean section is the delivery mode of choice, but vaginal/instrumental delivery could be tried if deemed quicker, particularly in the second stage of labor. Diagnosis-to-delivery interval should ideally be less than 30 minutes; however, if it is expected to be lengthy, measures to relieve cord compression should be attempted. Manual elevation of the presenting part and Vago's method (bladder filling) are the most commonly used maneuvers. Care should be given not to cause cord spasm with excessive manipulation. Simulation training has been shown to improve/maintain all aspects of management and documentation. Prompt diagnosis and interventions and the positive impact of neonatal management have significantly improved the neonatal outcome.
PubMed: 30174462
DOI: 10.2147/IJWH.S130879 -
Midwifery Today With International... 2013Research shows that artificially rupturing the amniotic sac (amniotomy) can cause umbilical cord prolapse. Amniotomy became a routine part of obstetrical care with the... (Review)
Review
Research shows that artificially rupturing the amniotic sac (amniotomy) can cause umbilical cord prolapse. Amniotomy became a routine part of obstetrical care with the introduction of active management, without evidence of benefit. In the 30 years since active management was introduced, the rate at which amniotomy causes umbilical cord prolapse has not been directly studied. Two controlled studies from Turkey from 2002 and 2006 are the only published studies that provide enough data to extract the rate at which cord prolapse follows amniotomy. They show that 1 cord prolapse results from every 300 amniotomies (0.3%). There is data suggesting amniotomy may also increase neonatal GBS infection, maternal pain and fetal blood loss if placental blood vessels are punctured.
Topics: Amnion; Cesarean Section; Extraction, Obstetrical; Female; Humans; Infant Welfare; Infant, Newborn; Labor, Induced; Maternal Welfare; Midwifery; Obstetric Labor Complications; Obstetric Surgical Procedures; Perinatal Care; Pregnancy; Umbilical Cord
PubMed: 24511837
DOI: No ID Found -
Diagnostics (Basel, Switzerland) Nov 2022Umbilical cord prolapse can be a life-threatening obstetrical event involving the fetus due to sudden oxygenated blood flow obstruction. These types of events most often...
Umbilical cord prolapse can be a life-threatening obstetrical event involving the fetus due to sudden oxygenated blood flow obstruction. These types of events most often happen in labor and are associated with obstetric maneuvers. Rarely, a clinical examination can diagnose the condition, but the situation is usually detected secondary to an abnormal cardiotocography trace. We present several clinical cases where a CTG trace was used to infer umbilical cord prolapse.
PubMed: 36428904
DOI: 10.3390/diagnostics12112845 -
Obstetrical & Gynecological Survey Aug 2020Umbilical cord prolapse is a rare occurrence and is a life-threatening emergency for the fetus. These events are unpredictable and unpreventable. Umbilical cord prolapse... (Review)
Review
IMPORTANCE
Umbilical cord prolapse is a rare occurrence and is a life-threatening emergency for the fetus. These events are unpredictable and unpreventable. Umbilical cord prolapse requires swift diagnosis and management for optimal outcome.
OBJECTIVE
The aim of this review is to describe the incidence, risk factor, pathophysiology, diagnosis, and management of this rare but potentially life-threatening event.
EVIDENCE ACQUISITION
A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched.
RESULTS
There were 200 articles identified, with 53 being the basis of review. Multiple risk factors for a umbilical cord prolapse have been suggested including fetal malpresentation or abnormal lie, prematurity, multifetal gestation, and polyhydramnios. The diagnosis is largely made by examination and found after rupture of membranes, and most often, examination is prompted by fetal heart rate decelerations. The management of umbilical cord prolapse is expedited delivery; however, there are rare specific scenarios in which immediate delivery is not possible and efforts should be made to relieve cord compression.
CONCLUSIONS
Rapid identification of an umbilical cord prolapse facilitates management and increases likelihood of an optimal outcome. The management is an expedited delivery with efforts to relieve cord compression until delivery can be achieved.
RELEVANCE
Umbilical cord prolapse is a rare but a life-threatening obstetrical emergency.
Topics: Female; Humans; Incidence; Pregnancy; Pregnancy Complications; Prolapse; Risk Factors; Umbilical Cord
PubMed: 32856717
DOI: 10.1097/OGX.0000000000000818