Umbilical Cord Prolapse and Evaluation of Maternal and Neonatal Outcomes

Abstract

Aim Umbilical cord prolapse(UCP) is the presence of the umbilical cord preceding ahead of the fetal presenting part with absent membranes through the cervical canal. Delayed delivery can even cause stillbirth. Despite improved obstetric care and liberal use of cesarean delivery, the incidence has not been decreased dramatically. The purpose of this study was to review the literature about umbilical cord prolapse and represent clinical experience to improve neonatal outcomes. Material and Method A retrospective cohort study was conducted between October 2016-December 2019. Patients who experienced UCP were evaluated in terms of antenatal care, risk factors for UCP, labor progress, and neonatal outcomes.Maternal and neonatal outcomes of these patients were compared with the women who underwent emergent cesarean delivery due to acute fetal distress(AFD). Results Forty-three pregnant women experienced UCP with an incidence of 11/10.000.The diagnosis was achieved by palpating the umbilical cord during the vaginal examination after detecting fetal bradycardia, severe deceleration or loss of reactivity in the Non-Stress Test. In two cases umbilical cord had seen in the vaginal introitus.The mean cervical dilatation of the patients was 5,4 cm. The number of women who underwent emergent cesarean, recruited in the study was 255. The APGAR scores were similar. Conclusion Emergent cesarean delivery could improve neonatal outcomes in patients diagnosed with UCP. Fetal wellbeing monitorization, especially in the one hour from rupture of fetal membranes, provides remarkable clues for UCP diagnosis. To improve neonatal outcomes, there should be one available operating theatre for emergent circumstances and a pediatrician for neonatal resuscitation.

Keywords

• Umbilical cord prolapse
• emergent cesarean
• stillbirth
• acute fetal distress
• diagnosis delivery interval

Umblikal Kord Prolapsusu(UCP) Maternal ve Neonatal Sonuçları

Abstract

Amaç Umblikal Kord Prolapsusu (UCP) ,umblikal kordun servikal kanal boyunca fetal prezentasyonun önünde membransız bir şekilde bulunmasıdır. Geciktirilmiş doğum eylemi ölü doğumla sonuçlanabilir. Obstetrik bakımın gelişmesi ve sezaryan ile doğumun bu kadar yaygınlaşmasına rağmen insidanslarda dramatik bir düşüş yaşanmamıştır. Bu çalışmanın amacı UCP konusundaki literatürü gözden geçirmek ve neonatal sonuçları iyileştirmek için klinik tecrübeleri sunmaktır. Materyel ve Metot Ekim 2016- Aralık 2019 arasında yapılan retrospektif kohort çalışmalar birleştirilmiştir. UCP yaşamış bir hasta antenatal bakım, UCP risk faktörleri, doğum süreci ve neonatal sonuçlar açısından değerlendirilmiştir.Bu hastaların maternal ve neonatal sonuçları, akut fetal distress(AFD) nedeniyle acil sezaryen doğum yapılan kadınlarla karşılaştırıldı. Sonuç 43 gebe 11/10.000 insidans oranı ile UCP yaşamıştır. Teşhis, Non-Stress Test ‘te fetal bradikardi, fetal kalp hızında ciddi yavaşlama veya reaktivite kaybı tespit edildikten sonra vajinal muayene sırasında umblikal kordun palpe edilmesiyle sağlandı. Hastalarda ki ortalama servikal dilatasyon 5,4 cm idi. Çalışmaya alınan acil sezaryen uygulanan kadın sayısı 255'tir.Yenidoğanların APGAR skorları benzerdi. Tartışma UCP teşhisi alan hastaların acil sezaryene alımı neonatal etkileri iyileştirebilir. Fetal monitörizasyon, özellikle fetal membran rüptüründen sonraki bir saat içinde, UCP teşhisi için dikkate değer ipuçları sağlar. Yenidoğan üzerindeki etkileri iyileştirmek için, acil durumlar için uygun bir ameliyathane ve yenidoğan resüsitasyonu için bir pediatrist olmalıdır.

Keywords

• Umblikal kord prolapsusu
• acil sezaryen
• ölü doğum
• akut fetal distres
• teşhis doğum aralığı

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