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The Journal of Maternal-fetal &... Nov 2013Amniotomy has become a routine part of obstetrical care. It was added along with other procedures adopted 50+ years ago without strong evidence. The scientific data... (Review)
Review
Amniotomy has become a routine part of obstetrical care. It was added along with other procedures adopted 50+ years ago without strong evidence. The scientific data supporting this procedure is poor while there is data suggesting it may increase the frequency of cord prolapse, neonatal GBS infection, pain and fetal blood loss if placental blood vessels are punctured. The incidence of cord prolapse overall reported in the literature ranges from 0% to 0.7%. The rate at which cord prolapse immediately follows amniotomy has not been directly studied but is reported in 4 case controlled studies.
Topics: Amnion; Female; Humans; Infant, Newborn; Obstetric Labor Complications; Obstetric Surgical Procedures; Pain, Postoperative; Pregnancy; Umbilical Cord; Vasa Previa
PubMed: 23611559
DOI: 10.3109/14767058.2013.798286 -
Journal of Obstetrics and Gynaecology... Mar 2018
Topics: Adult; Female; Humans; Pregnancy; Prolapse; Ultrasonography, Prenatal; Umbilical Cord
PubMed: 28396250
DOI: 10.1016/j.jogc.2016.11.013 -
Taiwanese Journal of Obstetrics &... May 2022To investigate the incidence of umbilical cord prolapse (UCP) and its influence on infant prognosis in pregnant women with preterm premature rupture of membranes (PPROM).
OBJECTIVE
To investigate the incidence of umbilical cord prolapse (UCP) and its influence on infant prognosis in pregnant women with preterm premature rupture of membranes (PPROM).
MATERIALS AND METHODS
We conducted a retrospective cohort study in a single tertiary perinatal center between 2009 and 2017. Singleton pregnancies with PPROM that occurred between 22 and 33 weeks of gestation were included. Infantile composite adverse outcome consisted of death, severe intraventricular hemorrhage, cystic periventricular leukomalacia, necrotizing enterocolitis, and sepsis before discharge. Infantile outcomes were compared between pregnancies that were complicated by UCP and those that were not.
RESULTS
Out of 208 singleton pregnancies included in the analysis, UCP occurred in 12 (5.8%) cases. The gestational age of pregnancies with UCP was significantly lesser than that of those without UCP. The incidence of infantile composite adverse outcome in patients with UCP was 16.7%, and this was not significantly higher than the incidence in patients without UCP (6.6%, P = 0.21). UCP was not shown to be associated with infantile composite adverse outcome in a multivariate regression model. Gestational age <25 weeks at delivery was significantly associated with infantile composite adverse outcome.
CONCLUSIONS
The incidence of UCP was 5.8% among singleton pregnancies, with PPROM being managed expectantly between 22 and 33 weeks' gestation. Preterm UCP may not be associated with infantile adverse outcomes provided emergency cesarean delivery is available at all time.
Topics: Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Pregnancy; Pregnancy Outcome; Prolapse; Retrospective Studies; Umbilical Cord
PubMed: 35595443
DOI: 10.1016/j.tjog.2022.03.016 -
European Journal of Obstetrics,... Dec 2001A 29-year-old G6 P3023 woman presented at 37 weeks' gestation with rupture of membranes and oligohydramnios. After informed consent was obtained, a successful external...
A 29-year-old G6 P3023 woman presented at 37 weeks' gestation with rupture of membranes and oligohydramnios. After informed consent was obtained, a successful external cephalic version (ECV) was performed. The patient went into spontaneous labor, but about 2h after the ECV, the umbilical cord prolapsed, necessitating cesarean section. Umbilical cord prolapse is a possible complication of ECV in patients with rupture of membranes and oligohydramnios.
Topics: Adult; Cesarean Section; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Oligohydramnios; Pregnancy; Prolapse; Umbilical Cord; Version, Fetal
PubMed: 11788188
DOI: 10.1016/s0301-2115(01)00389-x -
Acta Obstetricia Et Gynecologica... Jan 2021Umbilical cord prolapse is a major obstetric emergency associated with significant perinatal complications. However, there is no consensus on the optimal...
INTRODUCTION
Umbilical cord prolapse is a major obstetric emergency associated with significant perinatal complications. However, there is no consensus on the optimal decision-to-delivery interval, as many previous studies have shown poor correlation between the interval and umbilical cord arterial blood gas or perinatal outcomes. We aim to investigate whether bradycardia-to-delivery or decision-to-delivery interval was related to poor cord arterial pH or adverse perinatal outcome in umbilical cord prolapse.
MATERIAL AND METHODS
This was a retrospective study conducted at a university tertiary obstetric unit in Hong Kong. All women with singleton pregnancy complicated by cord prolapse during labor between 1995 and 2018 were included. Women were categorized into three groups. Group 1: persistent bradycardia; Group 2: any type of decelerations without bradycardia; and Group 3: normal fetal heart rate. The main outcome was cord arterial blood gas results of the newborns in different groups. Maternal demographic data and perinatal outcomes were reviewed. Correlation analysis between cord arterial blood gas result and time intervals including bradycardia-to-delivery, deceleration-to-delivery, and decision-to-delivery were performed for the different groups with Spearman test.
RESULTS
There were 34, 30, and 50 women in Groups 1, 2, and 3, respectively. Cord arterial pH and base excess did not correlate with decision-to-delivery interval in any of the groups, but they were inversely correlated with bradycardia-to-delivery interval in Group 1 (Spearman's ρ = -.349; P = .043 and Spearman's ρ = -.558; P = .001, respectively). The cord arterial pH drops at 0.009 per minute with bradycardia-to-delivery interval in Group 1 (95% CI 0.0180-0.0003). The risk of significant acidosis (pH < 7) was 80% when bradycardia-to-delivery interval was >20 minutes, and 17.2% when the interval was <20 minutes.
CONCLUSIONS
There is significant correlation between bradycardia-to-delivery interval and cord arterial pH in umbilical cord prolapse with fetal bradycardia but not in cases with decelerations or normal heart rate. The drop of cord arterial pH is rapid and urgent delivery is essential in such situations.
Topics: Adult; Blood Gas Analysis; Bradycardia; Female; Fetal Diseases; Hong Kong; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Prolapse; Retrospective Studies; Umbilical Cord
PubMed: 32862427
DOI: 10.1111/aogs.13985 -
Archives of Gynecology and Obstetrics Sep 2016To demonstrate the clinical course and the obstetric risk factors for umbilical cord prolapse.
OBJECTIVES
To demonstrate the clinical course and the obstetric risk factors for umbilical cord prolapse.
METHODS
The clinical course of reported cases of umbilical cord prolapse that occurred in Japan between 2007 and 2011 was retrospectively analyzed. The obstetric risk factors for umbilical cord prolapse were investigated by a nationwide population-based case-cohort study.
RESULTS
Three hundred and sixty-nine cases (0.018 %) of fore-lying/prolapsed umbilical cord in 2,037,460 deliveries were analyzed. Most cases of fore-lying umbilical cord were diagnosed by an ultrasound scan (78 %), whereas umbilical cord prolapse was most frequently diagnosed by an internal examination (63 %). Umbilical cord prolapse was found to be significantly associated with the following factors: multiple pregnancy [odds ratio (OR) 3.57; 95 % confidence interval (CI) 2.60, 4.90], non-vertex presentation (OR 4.67; 95 %CI 3.73, 5.86), preterm labor (OR 2.28; 95 %CI 1.83, 2.83), premature rupture of membranes (OR 3.84; 95 %CI 3.10, 4.77), prolapsed amniotic bag (OR 12.31; 95 %CI 9.00, 16.85), polyhydramnios (OR 2.89; 95 %CI 1.49, 5.61), and a birth weight of <2500 g (OR 2.26; 95 %CI 1.84, 2.79).
CONCLUSION
The current study is the largest in Japan to demonstrate the obstetric clinical course and risk factors associated with umbilical cord prolapse. Prolapsed amniotic bag, labor and rupture of membrane during premature period, and fetal abnormal presentation induced by multiple pregnancy, and polyhydramnios were high risk situation for umbilical cord prolapse.
Topics: Adult; Birth Weight; Cohort Studies; Female; Humans; Infant, Newborn; Obstetric Labor Complications; Pregnancy; Prolapse; Retrospective Studies; Risk Factors; Umbilical Cord
PubMed: 26714678
DOI: 10.1007/s00404-015-3996-3 -
BMC Pregnancy and Childbirth Jun 2023Rapid delivery is important in cases of umbilical cord prolapse to prevent hypoxic injury to the fetus/neonate. However, the optimal decision-to-delivery interval...
BACKGROUND
Rapid delivery is important in cases of umbilical cord prolapse to prevent hypoxic injury to the fetus/neonate. However, the optimal decision-to-delivery interval remains controversial.
OBJECTIVE
The aim of the study was to investigate the association between the decision-to-delivery interval in women with umbilical cord prolapse, stratified by fetal heart rate pattern at diagnosis, and neonatal outcome.
STUDY DESIGN
The database of a tertiary medical center was retrospectively searched for all cases of intrapartum cord prolapse between 2008 and 2021. The cohort was divided into three groups according to findings on the fetal heart tracing at diagnosis: 1) bradycardia; 2) decelerations without bradycardia; and 3) reassuring heart rate. The primary outcome measure was fetal acidosis. The correlation between cord blood indices and decision-to-delivery interval was analyzed using Spearman's rank correlation coefficient.
RESULTS
Of the total 103,917 deliveries performed during the study period, 130 (0.13%) were complicated by intrapartum umbilical cord prolapse. Division by fetal heart tracing yielded 22 women (16.92%) in group 1, 41 (31.53%) in group 2, and 67 (51.53%) in group 3. The median decision-to-delivery interval was 11.0 min (IQR 9.0-15.0); the interval was more than 20 min in 4 cases. The median cord arterial blood pH was 7.28 (IQR 7.24-7.32); pH was less than 7.2 in 4 neonates. There was no correlation of cord arterial pH with decision-to-delivery interval (Spearman's Ρ = - 0.113; Ρ = 0.368) or with fetal heart rate pattern (Spearman's Ρ = .425; Ρ = .079, Ρ = - .205; Ρ = .336, Ρ = - .324; Ρ = .122 for groups 1-3, respectively).
CONCLUSION
Intrapartum umbilical cord prolapse is a relatively rare obstetric emergency with an overall favorable neonatal outcome if managed in a timely manner, regardless of the immediately preceding fetal heart rate. In a clinical setting which includes a high obstetric volume and a rapid, protocol-based, response, there is apparently no significant correlation between decision-to-delivery interval and cord arterial cord pH.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Retrospective Studies; Bradycardia; Fetal Diseases; Umbilical Cord; Fetal Blood; Prolapse
PubMed: 37349738
DOI: 10.1186/s12884-023-05788-y -
The Practising Midwife Jun 2010
Topics: Adult; Cesarean Section; Female; Humans; Infant, Newborn; Maternal Welfare; Nurse's Role; Obstetric Labor Complications; Poverty; Pregnancy; Pregnancy Outcome; Prenatal Care; Prolapse; Rural Population; Rwanda; Umbilical Cord
PubMed: 20586345
DOI: No ID Found -
American Journal of Obstetrics and... May 2022
Topics: Female; Humans; Obstetric Labor Complications; Pregnancy; Prolapse; Umbilical Cord
PubMed: 34902318
DOI: 10.1016/j.ajog.2021.12.009 -
Seminars in Perinatology Oct 1996Premature rupture of the membranes (PROM), membrane rupture before the onset of labor, occurs in 2% to 18% of pregnancies. The time from PROM to delivery (latency) is... (Review)
Review
Premature rupture of the membranes (PROM), membrane rupture before the onset of labor, occurs in 2% to 18% of pregnancies. The time from PROM to delivery (latency) is usually less than 48 hours in term pregnancy. Therefore, the risks of PROM at term are related to fetal distress, prolapsed cord, abruptio placenta, and rarely, infection. Preterm PROM (pPROM), PROM before 37 weeks' gestation, accounts for 20% to 40% of PROM, and the incidence is doubled in multiple gestations. The latency period in pPROM is inversely related to the gestational age thereby increasing the risks of oligohydramnios and infection in very premature infants and their mothers. Because pPROM is associated with 30% to 40% of premature births, pPROM is also responsible for the neonatal problems resulting from prematurity. This review examines the impact of PROM on the neonate including fetal distress, prematurity, infection, pulmonary hypoplasia, and restriction deformations.
Topics: Female; Fetal Distress; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infections; Lung Diseases; Oligohydramnios; Pregnancy; Pregnancy Outcome
PubMed: 8912991
DOI: 10.1016/s0146-0005(96)80004-8