title: [Umbilical cord prolapse: a case study over 23 years].
abstract: OBJECTIVE
  To determine the incidence of umbilical cord prolapse, the characteristics of the population, and to evaluate its management and the neonatal prognosis.
  
  
  METHODS
  Ninety-three cases of cord prolapse that occurred between January 1986 and December 2009 at our level III labour ward were studied retrospectively.
  
  
  RESULTS
  The incidence of cord prolapse was 0.18%. It occurred in 66.7% of cases in multiparous patients, in 19.4% of cases in twin pregnancies, and in 41.9% of cases in breech presentations. In 34.4% of cases, the gestational age was less than 37 weeks. Birth occurred vaginally in 33.3% of cases with a delivery time interval significantly less than for caesarean sections (P<0.001). At complete cervical dilation, more than three quarter of patients delivered vaginally. Vaginal birth was significantly more frequent in case of breech (P=0.009) and second twin (P=0.03). Parity did not influence birth route. Neonates with a birth weight less than 2500 g (30.1%) had significantly more frequently an Apgar score less than 7 at 5 min (P=0.02), a higher rate of transfer to intensive care (P<0.001) and a longer hospital stay (P=0.002). We report six neonatal deaths (6.5%). Neonatal status was not influenced by the time interval for delivery.
  
  
  CONCLUSIONS
  Umbilical cord prolapse is still nowadays a serious complication of pregnancy, responsible for a significant rate of neonatal mortality. The aim in case of cord prolapse is to obtain fetal delivery the quickest way possible so as to improve the neonatal outcome. In some particular obstetrical situations such as breech presentations and second twin deliveries, birth occurs faster if performed vaginally as shown by our case study.
authors: Service de gynécologie-obstétrique, hôpital Saint-Jacques, 4, place Saint-Jacques, 25000 Besançon, France.
authors: E
authors: E
authors: Gannard-Pechin
authors: R
authors: R
authors: Ramanah
authors: S
authors: S
authors: Cossa
authors: B
authors: B
authors: Mulin
authors: R
authors: R
authors: Maillet
authors: D
authors: D
authors: Riethmuller
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight / Q000502:physiology; D001946:Breech Presentation / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006554:Hernia, Umbilical / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011391:Prolapse; D012189:Retrospective Studies; D013997:Time Factors; D014470:Umbilical Cord / Q000473:pathology; D055815:Young Adult