Umbilical Cord Prolapse and Evaluation of Maternal and Neonatal Outcomes

Öz

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.

Anahtar Kelimeler

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

Umblikal Kord Prolapsusu(UCP) Maternal ve Neonatal Sonuçları

Öz

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.

Anahtar Kelimeler

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

Kaynakça

1. Referans 1. Technical Working Group WHO. Short Communication : Care in Normal Birth: A Practical Guide Birth. 1997;24(2):121-3.
2. Referans 2. Behbehani S, Patenaude V, Abenhaim HA. Maternal risk factors and outcomes of umbilical cord prolapse: a population-based study. Journal of Obstetrics and Gynaecology Canada. 2016;38(1):23-8.
3. Referans 3. Ahmed WAS, Hamdy MA. Optimal management of umbilical cord prolapse. International journal of women's health. 2018;10:459.
4. Referans 4. Boyle JJ, Katz VL. Umbilical cord prolapse in current obstetric practice. Obstetrical & gynecological survey. 2005;60(11):712-3.
5. Referans 5. Holbrook BD, Phelan ST. Umbilical cord prolapse. Obstetrics and Gynecology Clinics. 2013;40(1):1-14.
6. Referans 6. Siassakos D, Hasafa Z, Sibanda T et al. Retrospective cohort study of diagnosis–delivery interval with umbilical cord prolapse: the effect of team training. BJOG: An International Journal of Obstetrics & Gynaecology. 2009;116(8):1089-96.
7. Referans 7. Huang J-P, Chen C-P, Chen C-P, Wang K-G, Wang K-L. Term pregnancy with umbilical cord prolapse. Taiwanese Journal of Obstetrics and Gynecology. 2012;51(3):375-80.
8. Referans 8. Enakpene C, Omigbodun A, Arowojolu A. Perinatal mortality following umbilical cord prolapse. International Journal of Gynecology & Obstetrics. 2006;95(1):44-5.

9. Referans 9. Wasswa EW, Nakubulwa S, Mutyaba T. Fetal demise and associated factors following umbilical cord prolapse in Mulago hospital, Uganda: a retrospective study. Reproductive health. 2014;11(1):12.
10. Referans 10. Kumar A, George N. Cord Prolapse and Transverse Lie. Labour Room Emergencies: Springer; 2020. p. 317-26.
11. Referans 11. Vago T. Prolopse of the umbilical cord: A method of management. American journal of obstetrics and gynecology. 1970;107(6):967-9.
12. Referans 12. Pediatrics AAo, Obstetricians ACo, Gynecologists. Guidelines for perinatal care: Amer Academy of Pediatrics; 2002.
13. Referans 13. Schauberger CW, Chauhan SP. Emergency cesarean section and the 30-minute rule: definitions. American journal of perinatology. 2009;26(03):221-6.
14. Referans 14. Obstetricians ACo, Gynecologists. ACOG Practice Bulletin No. 120: Use of prophylactic antibiotics in labor and delivery. Obstetrics and gynecology. 2011;117(6):1472.
15. Referans 15. Wu P, Poole TC, Pickett JA, Bhat A, Lees CC. Current obstetric guidelines on thromboprophylaxis in the United Kingdom: evidence based medicine? European Journal of Obstetrics & Gynecology and Reproductive Biology. 2013;168(1):7-11.
16. Referans 16. Bush M, Eddleman K, Belogolovkin V. Umbilical cord prolapse. Uptodate. 2016;16(3):10-4.
17. Referans 17. Barros FC, del Pilar Vélez M. Temporal trends of preterm birth subtypes and neonatal outcomes. Obstetrics & Gynecology. 2006;107(5):1035-41.
18. Referans 18. Demol S, Bashiri A, Furman B, Maymon E, Shoham-Vardi I, Mazor M. Breech presentation is a risk factor for intrapartum and neonatal death in preterm delivery. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2000;93(1):47-51.
19. Referans 19. Barclay M. Umbilical cord prolapse and other cord accidents. Gynecology and Obstetrics. 1989;2:1-7.
20. Referans 20. Gabbay-Benziv R, Maman M, Wiznitzer A, Linder N, Yogev Y. Umbilical cord prolapse during delivery–risk factors and pregnancy outcome: a single center experience. The Journal of Maternal-Fetal & Neonatal Medicine. 2014;27(1):14-7.
21. Referans 21. Prabulos A-M, Philipson EH. Umbilical cord prolapse: is the time from diagnosis to delivery critical? Obstetrical & gynecological survey. 1998;53(9):529-31.
22. Referans 22. Alouini S, Mesnard L, Megier P, Lemaire B, Coly S, Desroches A. Procidence du cordon: prise en charge obstétricale et conséquences néonatales. Journal de gynécologie obstétrique et biologie de la reproduction. 2010;39(6):471-7.
23. Referans 23. Usta IM, Mercer BM, Sibai BM. Current obstetrical practice and umbilical cord prolapse. American journal of perinatology. 1999;16(09):0479-84.
24. Referans 24. Murphy D, MacKenzie I. The mortality and morbidity associated with umbilical cord prolapse. BJOG: An International Journal of Obstetrics & Gynaecology. 1995;102(10):826-30.
25. Referans 25. Hamilton EF, Simoneau G, Ciampi A, Warrick P, Collins K, Smith S, et al. Descent of the fetal head (station) during the first stage of labor. American journal of obstetrics and gynecology. 2016;214(3):360. e1-. e6.
26. Referans 26. Rajakumar C, Garber A, Rao PM, Rousseau G, Dumitrascu GA, Posner GD. Umbilical cord prolapse in a labouring patient: a multidisciplinary and interprofessional simulation scenario. Cureus. 2017;9(9).
27. Referans 27. Flentje M, Schott M, Woltemate A-L, Jantzen J-P. Interdisciplinary Simulation of Emergency Caesarean Section to Improve Subjective Competence. Zeitschrift fur Geburtshilfe und Neonatologie. 2017;221(5):226-34.
28. Referans 28. Zhang J, Troendle JF, Yancey MK. Reassessing the labor curve in nulliparous women. American journal of obstetrics and gynecology. 2002;187(4):824-8.
29. Referans 29. Boushra M, Stone A, Rathbun KM. Umbilical Cord Prolapse. StatPearls [Internet]: StatPearls Publishing; 2019.