Umbilical cord prolapse and perinatal outcome in a tertiary institution: a periodic review

Abstract

Cord prolapse is one of the obstetric emergencies in labour, posing a life threatening suituation for the foetus. With a live foetus, timely delivery at detection of the prolapse reduces the high perinatal morbidity and mortality. Generally, the management of this condition seems to pose a persisting challenge. To determine the incidence of cord prolapse, predisposing factors and perinatal outcome of cases of cord prolapse managed in the University of Port-Harcourt Teaching Hospital (UPTH). A review of thirty eight (38) cases of foetal umbilical cord prolapse, managed at the UPTH, Port Harcourt, Nigeria from January 1^st, 2009 to December 31^st, 2013. Data was analyzed using SPSS windows version 20 and results presented in frequencies and percentages. There were 15,840 deliveries with 38 cases of cord prolapse, giving an incidence of 0.24%, or 2.4 per 1000 deliveries. Among the patients, 47.4% were unbooked while 52.6% were booked. The highest incidence occurred in women aged 30-34 years; and mainly among multiparous women which accounted for 55.2% of the patients. Spontaneous rupture of membranes with high presenting part was the highest contributing factor (26.3%), followed by multiparity (23.7%). There were foetal demise on presentation to the hospital in 18% of cases (mainly in the unbooked patients). Of the 10 fetal losses, 8 were still birth. Perinatal mortality was 233 per 1000 deliveries. Still. birth constituted the bulk of fetal loss in cord prolapsed. Spontaneous rupture of foetal membranes and unbooked patients accounts for most of the perinatal mortality Measures that will improve antenatal care registration will allow for better surveillance and management of those at risk of spontaneous rupture of fetal membranes and help in reducing the associated high perinatal mortality.

Keywords: Unbooked, Membranes, Cord prolapsed, Perinatal mortality