[Management of umbilical cord prolapse and neonatal outcomes].
OBJECTIVE
To evaluate the obstetrical management of umbilical cord prolapse and the neonatal outcomes.


METHODS
Retrospective study of 57 prolapses of umbilical cord between 1998 and 2009. Arterial pH of umbilical cord, Apgar score and diagnosis delivery time (DDT) were analyzed.


RESULTS
The incidence of the cord prolapse was of 1.25 for 1000 deliveries. Cord prolapse occurred with the artificial rupture of membranes in 24 cases (42%) out of 57. There were 48 caesarean births. There were three hydramnios and seven cases of twin pregnancy. The mean pH in the umbilical arteries was 7.15 ± 0.13 in 27 cases. The mean Apgar for the 57 newborns was 6 ± 3 at 1 min and 8 ± 3 at 5 min. The mean DDT was 18 ± 8 min (range: 3-44). In 17 cases out of 27, the mean arterial umbilical pH was 7.07 ± 0.09. Fifteen newborns (26%) had a 5-minute Apgar score less than 7 and were admitted in intensive care unit. The mean Apgar score in the nine vaginal deliveries was 8 ± 4 min. In case of cephalic presentations without associated foetal or maternal pathologies there was a tendency of a better pH when the DDT was shorter. In non-cephalic presentations (14 cases), the mean Apgar score was 8 ± 3 at 5 min. The mean pH measured in eight cases was 7.20 ± 0.13 with mean DDT of 20 minutes.


CONCLUSIONS
The umbilical cord prolapse remains a serious event for the newborns. The reduction of the DDT in cephalic presentation seems to be correlated to a better neonatal state. The caesarean section is the preferential way of childbirth.
Alouini
S
S
Département obstétrique et gynécologie, centre hospitalier régional d'Orléans, 1, Porte-Madeleine, 45000 Orléans, France. alouini.s@wanadoo.fr
Mesnard
L
L
Megier
P
P
Lemaire
B
B
Coly
S
S
Desroches
A
A
D001034:Apgar Score; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000601:surgery*; D006831:Polyhydramnios / Q000453:epidemiology / Q000601:surgery; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011391:Prolapse; D012189:Retrospective Studies; D016896:Treatment Outcome; D014469:Umbilical Arteries / Q000502:physiology; D014470:Umbilical Cord / Q000473:pathology* / Q000601:surgery*