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Medecine Et Sante Tropicales 2015Umbilical cord prolapse is an obstetrical emergency that is life-threatening for the fetus. This retrospective cross-sectional study examined cases of pulsating...
UNLABELLED
Umbilical cord prolapse is an obstetrical emergency that is life-threatening for the fetus. This retrospective cross-sectional study examined cases of pulsating umbilical cord prolapses at our level-3 maternity unit over the past three years and sought to assess their prognosis. Cord prolapse occurred in 0.27% of deliveries. The women's mean age was 28 years, and 51% of the women were multiparous. Cesarean deliveries were performed in 96% of cases. Factors affecting neonatal outcome were the degree of cord prolapse (p = 0.0002981) and the appearance of amniotic fluid (p = 0.004078). The neonatal complications included admission to neonatal intensive care (33%), perinatal asphyxia (31%), prematurity (29%), neonatal infection (4%), and neonatal mortality (10%).
CONCLUSION
The fetus must be delivered rapidly, especially when the umbilical cord drops outside the mother's body and the amniotic fluid is meconial.
Topics: Adult; Cross-Sectional Studies; Female; Hospitals; Humans; Infant, Newborn; Infant, Newborn, Diseases; Madagascar; Pregnancy; Pregnancy Complications; Prognosis; Prolapse; Retrospective Studies; Umbilical Cord
PubMed: 26742556
DOI: 10.1684/mst.2015.0454 -
Journal of Nippon Medical School =... 2012We present here a case of fore-lying of the umbilical cord. In this case, transvaginal sonography did not reveal the umbilical cord beyond the fetal head before maternal...
We present here a case of fore-lying of the umbilical cord. In this case, transvaginal sonography did not reveal the umbilical cord beyond the fetal head before maternal urination; however, 5 minute later, a fore-lying umbilical cord was revealed between the floating fetal head and the uterine cervix after urination. The present case indicates the importance of careful evaluation of preterm premature rupture of the membranes by means of transvaginal ultrasonography in predicting umbilical cord prolapse.
Topics: Female; Humans; Pregnancy; Pregnancy Complications; Prolapse; Ultrasonography; Umbilical Cord; Urination; Young Adult
PubMed: 22976608
DOI: 10.1272/jnms.79.284 -
Ultrasound in Obstetrics & Gynecology :... Oct 2021To assess objectively the degree of fetal head elevation achieved by different maneuvers commonly used for managing umbilical cord prolapse. (Observational Study)
Observational Study
OBJECTIVE
To assess objectively the degree of fetal head elevation achieved by different maneuvers commonly used for managing umbilical cord prolapse.
METHODS
This was a prospective observational study of pregnant women at term before elective Cesarean delivery. A baseline assessment of fetal head station was performed with the woman in the supine position, using transperineal ultrasound for measuring the parasagittal angle of progression (psAOP), head-symphysis distance (HSD) and head-perineum distance (HPD). The ultrasonographic measurements of fetal head station were repeated during different maneuvers, including elevation of the maternal buttocks using a wedge, knee-chest position, Trendelenburg position with a 15° tilt and filling the maternal urinary bladder with 100 mL, 300 mL and 500 mL of normal saline. The measurements obtained during the maneuvers were compared with the baseline measurements.
RESULTS
Twenty pregnant women scheduled for elective Cesarean section at term were included in the study. When compared with baseline (median psAOP, 103.6°), the knee-chest position gave the strongest elevation effect, with the greatest reduction in psAOP (psAOP, 80.7°; P < 0.001), followed by filling the bladder with 500 mL (psAOP, 89.9°; P < 0.001) and 300 mL (psAOP, 94.4°; P < 0.001) of normal saline. Filling the maternal bladder with 100 mL of normal saline (psAOP, 96.1°; P = 0.001), the Trendelenburg position (psAOP, 96.8°; P = 0.014) and elevating the maternal buttocks (psAOP, 98.3°; P = 0.033) gave modest elevation effects. Similar findings were reported for HSD and HPD. The fetal head elevation effects of the knee-chest position, Trendelenburg position and elevation of the maternal buttocks were independent of the initial fetal head station, but that of bladder filling was greater when the initial head station was low.
CONCLUSIONS
To elevate the fetal presenting part, the knee-chest position provides the best effect, followed by filling the maternal urinary bladder with 500 mL then 300 mL of fluid, respectively. Filling the bladder with 100 mL of fluid, the Trendelenburg position and elevation of the maternal buttocks have modest effects. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Adult; Cesarean Section; Female; Fetus; Head; Humans; Labor Presentation; Patient Positioning; Perineum; Pregnancy; Preoperative Period; Prolapse; Prospective Studies; Term Birth; Ultrasonography, Prenatal; Umbilical Cord
PubMed: 33219729
DOI: 10.1002/uog.23544 -
Reproductive Health Feb 2014Umbilical cord prolapse is an obstetric complication associated with high perinatal morbidity and mortality. A few interventions may improve fetal outcome. In developed...
BACKGROUND
Umbilical cord prolapse is an obstetric complication associated with high perinatal morbidity and mortality. A few interventions may improve fetal outcome. In developed countries these have advanced to giving intrauterine fetal resuscitation. Conditions in low resource settings do not allow for some of these advanced techniques. Putting the mother in knee chest position and immediate delivery may be the only options possible.We set out to determine the incidence of fetal demise and associated factors following umbilical cord prolapsed (UCP) in Mulago Hospital, Uganda.
METHODS
In a retrospective study conducted in Mulago hospital, Uganda, file records of mothers who delivered between 1st January 2000 to 31st December 2009 and had pregnancies complicated by umbilical cord prolapse with live fetus were selected. We collected information on referral status, cord position, cervical dilatation, fetal heart state at the time of diagnosis of UCP, diagnosis to delivery interval, use of knee chest position, mode of delivery, birth weight and fetal outcome.We computed incidence of fetal demise following UCP and determined factors associated with fetal demise in pregnancies complicated by UCP.
RESULTS
Of 438 cases with prolapsed cord, 101(23%) lost their babies within 24 hours after birth or were delivered dead. This gave annual cumulative incidence of fetal death following UCP of 23/1000 live UCP cases delivered /year.The major factors associated with fetal outcome in pregnancies complicated by UCP included; diagnosis to delivery interval <30 min, RR 0.79 (CI 0.74-0.85), mode of delivery, RR 1.14 (CI 1.02-1.28), knee chest position, RR 0.81 (CI 0.70-0.95).
CONCLUSIONS
The annual cumulative incidence of fetal death in our study was 23/1000 live UCP cases delivery per year for the period of 10 years studied. Cesarean section reduced perinatal mortality by a factor of 2. Diagnosis to delivery interval <30 minutes and putting mother in knee chest position were protective against fetal death.
Topics: Delivery, Obstetric; Female; Fetal Death; Humans; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prolapse; Retrospective Studies; Uganda; Umbilical Cord
PubMed: 24485199
DOI: 10.1186/1742-4755-11-12 -
American Journal of Perinatology 1999The aim of this study was to assess the contribution of current obstetrical practice to the occurrence and complications of umbilical cord prolapse. Maternal and... (Comparative Study)
Comparative Study
The aim of this study was to assess the contribution of current obstetrical practice to the occurrence and complications of umbilical cord prolapse. Maternal and neonatal charts of 87 pregnancies complicated by true umbilical cord prolapse during a 5-year period were reviewed. Twin gestation and noncephalic presentations were common features (14 and 41%, respectively). Eighty-nine percent (77) of infants were delivered by cesarean section of which 29% were classical and 88% were primary. The mean gestational age at delivery was 34.0 +/- 6.0 weeks, and the mean birth weight was 2318 +/- 1159 g. Obstetrical intervention preceded 41 (47%) cases (the obstetrical intervention group): amniotomy (9), scalp electrode application (4), intrauterine pressure catheter insertion (6), attempted external cephalic version (7), expectant management of preterm premature rupture of membranes (14), manual rotation of the fetal head (1), and amnioreduction (1). There were 11 perinatal deaths. Thirty-three percent of the infants (32) had a 5-min Apgar score < 7 and 34% had a cord pH < 7.20. Neonatal seizures, intracerebral hemorrhage, necrotizing enterocolitis, hyaline membrane disease, persistent fetal circulation, sepsis, assisted ventilation, and perinatal mortality were comparable in the "obstetrical intervention" and "no-intervention" groups. Most of the neonatal complications occurred in infants < 32 weeks' gestation. We conclude that obstetrical intervention contributes to 47% of umbilical cord prolapse cases; however, it does not increase the associated perinatal morbidity and mortality.
Topics: Cesarean Section; Female; Humans; Incidence; Infant Mortality; Infant, Newborn; Obstetric Labor Complications; Obstetrics; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Probability; Prolapse; Registries; Risk Assessment; Umbilical Cord; United States
PubMed: 10774764
DOI: 10.1055/s-1999-6809 -
Le Mali Medical 2006Cord prolapse constitute an imprevisible accident of the period of labor and an important cause of perinatal mortality. The aim of our study was to determine the...
UNLABELLED
Cord prolapse constitute an imprevisible accident of the period of labor and an important cause of perinatal mortality. The aim of our study was to determine the frequency of cord prolapse, its etiological factors and to evaluate fetal prognosis.
MATERIAL AND METHODS
Our study was done in the department of obstetric and gynecology of the Treichville university teaching hospital. It is a descriptive prospective study that covers 4 years period, from January 1st 1997 to December 31st 2000.
RESULTS
We did record 16.924 deliveries with 47 cases of cord prolapse representing a frequency of 0.28% The influencial factors for occurrence of cord prolapse were: prematurity, multiple pregnancy, dystocic presentations and spontaneous rupture of membranes. 28% of our patients had pregnancy not at term. Twin pregnancies represented 23.4% and in 91% of the cases, prolapsed concerned the second twin. Our rate of cord prolapse associated with vertex presentation was 23.4%; 42.5% in breech and 12.8% in the case of shoulder presentation. Spontaneous rupture of membranes was the most frequent type. In 61.7% of the cases, the delivery was done by caesarian section. Cord prolapse was greatly lethal for the fetus with 36.2% of death occurring before the 5th minute of life.
CONCLUSION
Umbilical cord prolapse is a grave obstetrical complication that compromises fetal prognosis.
Topics: Cesarean Section; Female; Fetal Death; Humans; Incidence; Infant, Newborn; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Prolapse; Prospective Studies; Umbilical Cord
PubMed: 17390525
DOI: No ID Found -
International Journal of Gynaecology... Mar 2024
Topics: Female; Humans; Pregnancy; Africa South of the Sahara; Incidence; Obstetric Labor Complications; Perinatal Death; Perinatal Mortality; Prolapse; Retrospective Studies; Umbilical Cord
PubMed: 37927143
DOI: 10.1002/ijgo.15233 -
Journal de Gynecologie, Obstetrique Et... Oct 2010To evaluate the obstetrical management of umbilical cord prolapse and the neonatal outcomes.
OBJECTIVE
To evaluate the obstetrical management of umbilical cord prolapse and the neonatal outcomes.
METHODS
Retrospective study of 57 prolapses of umbilical cord between 1998 and 2009. Arterial pH of umbilical cord, Apgar score and diagnosis delivery time (DDT) were analyzed.
RESULTS
The incidence of the cord prolapse was of 1.25 for 1000 deliveries. Cord prolapse occurred with the artificial rupture of membranes in 24 cases (42%) out of 57. There were 48 caesarean births. There were three hydramnios and seven cases of twin pregnancy. The mean pH in the umbilical arteries was 7.15 ± 0.13 in 27 cases. The mean Apgar for the 57 newborns was 6 ± 3 at 1 min and 8 ± 3 at 5 min. The mean DDT was 18 ± 8 min (range: 3-44). In 17 cases out of 27, the mean arterial umbilical pH was 7.07 ± 0.09. Fifteen newborns (26%) had a 5-minute Apgar score less than 7 and were admitted in intensive care unit. The mean Apgar score in the nine vaginal deliveries was 8 ± 4 min. In case of cephalic presentations without associated foetal or maternal pathologies there was a tendency of a better pH when the DDT was shorter. In non-cephalic presentations (14 cases), the mean Apgar score was 8 ± 3 at 5 min. The mean pH measured in eight cases was 7.20 ± 0.13 with mean DDT of 20 minutes.
CONCLUSION
The umbilical cord prolapse remains a serious event for the newborns. The reduction of the DDT in cephalic presentation seems to be correlated to a better neonatal state. The caesarean section is the preferential way of childbirth.
Topics: Apgar Score; Cesarean Section; Delivery, Obstetric; Female; Humans; Incidence; Infant Mortality; Infant, Newborn; Obstetric Labor Complications; Polyhydramnios; Pregnancy; Pregnancy Outcome; Prolapse; Retrospective Studies; Treatment Outcome; Umbilical Arteries; Umbilical Cord
PubMed: 20609529
DOI: 10.1016/j.jgyn.2010.05.013 -
JPMA. the Journal of the Pakistan... Oct 2007To determine the significance of the Diagnosis to Delivery Interval (DDI) on perinatal outcome and maternal complications in patients with umbilical cord prolapse.
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.
Topics: Adult; Apgar Score; Asphyxia Neonatorum; Delivery, Obstetric; Female; Hospitals, University; Humans; Incidence; Infant, Newborn; Maternal Welfare; Obstetric Labor Complications; Pakistan; Perinatal Care; Pregnancy; Prolapse; Retrospective Studies; Risk Factors; Time Factors; Umbilical Cord
PubMed: 17990422
DOI: No ID Found -
American Journal of Obstetrics and... Jul 1951
Topics: Female; Humans; Labor, Obstetric; Pregnancy; Prolapse; Umbilical Cord; Work
PubMed: 14846821
DOI: 10.1016/0002-9378(51)91090-3