Emergency obstetrics care in a Nigerian tertiary hospital: a 20 year review of umblical cord prolapse

Abstract

Context: Umbilical cord prolapse is an obstetric emergency associated with high perinatal morbidity and mortality unless prompt delivery by the fastest and safest route is carried out. Objectives: To determine the incidence ofumbilical cord prolapse, predisposing factors, and fetal outcome. Study design, setting and subjects: A20 year retrospective study of all women who presented with umbilical cord prolapse atUniversity of MaiduguriTeachingHospital,Maiduguri.North-EasternNgeria. Results: During the study period there were 27,753 deliveries and 75 women had cord prolapse, giving the incidence of 1 in 370 deliveries (0.27%). Significantly more patients with non vertex presentation, twins and preterm delivery had cord prolapse. The highest occurrence was in those with unengaged presenting part(65.2%), spontaneous rupture of membrances(62.1%) and grandmultiparous women(57.6%). Caeserean section was carried out in 50% of cases, with mean decision-delivery interval of 77.1+- 21.7 minutes and 28/33(84.9%) of babies deliveredwithin 60minute had normalApgar scores. The Knee-chest position was most commonly used method of alleviating cord compression while arrangement for caesarean section was being made.The perinatalmortalitywas 27.3%. Conclusion: umbilical cord prolapse is a brisk obstetric emergency with high perinatalmorbidity andmortality unless prompt delivery is undertaken. Better communication and prompt response to emergency by the theatre teamto reduce the decision-delivery intervalwould improve the perinatal outcome.

Keywords: Umblical cord, grandmultiparous, Apgar, asphyxia, perinatal mortality and perinatal outcome