UMBILICAL-CORD PROLAPSE - IS THE TIME FROM DIAGNOSIS TO DELIVERY CRITICAL

OBJECTIVE: To review the peripartum clinical course of patients whose pregnancies are complicated by umbilical cord prolapse at a large teac hing hospital and to evaluate the time from diagnosis to delivery and its impact on neonatal outcome. STUDY DESIGN: The computerized perinat al database at Hartford Hospital was used to identify all cases of umb ilical cord prolapse from 1988 to 1994. Each maternal and neonatal cha rt was re viewed, and the following variables were evaluated: gestatio nal age, fetal presentation, status of membranes, time from diagnosis to delivery, mode of delivery, type of anesthesia and neonatal outcome . RESULTS: A total of 65 cases of umbilical cord prolapse were identif ied from 26,545 deliveries. There were 48 cases of frank cord prolapse and 17 of occult prolapse. Cord prolapse occurred with artificial rup ture of membranes in 51 % of cases and in 74 % of patients at term. Th ere were 59 cesarean births and 6 vaginal deliveries (5 in the occult prolapse group). The mean time from diagnosis to delivery teas 20 minu tes (range, 2 - 77). None of the neonates with an occult cord prolapse had a five-minute Apgar score < 7, while 9 (19 %) of the neonates wit h frank prolapse had a five-minute Apgar score < 7. In the frank prola pse group, there were five cases of neonatal asphyxia, all at a gestat ional age of greater than or equal to 36 weeks, and all were delivered by cesarean section. The mean delivery time for these affected neonat es was 11 minutes (range, 5 - 16). CONCLUSION: Our review indicated th at umbilical cord prolapse continues to be associated with poor perina tal outcomes in some cases despite emergency delivery in a modern, hig h-risk obstetric unit. The asphyxiated neonate had a shorter-than-aver age time from diagnosis to delivery, suggesting that the time from dia gnosis to delivery may not be the only critical determinant of neonata l outcome, particularly with frank cord prolapse. Occult cord prolapse was associated with less perinatal morbidity when compared to frank p rolapse.