title: Umbilical cord presentation after use of a trans-cervical balloon catheter.
abstract: OBJECTIVE
  To examine the incidence of umbilical cord presentation, including cord prolapse (UCP) and cord descent (UCD), after the use of a trans-cervical balloon catheter (TCBC), such as a Foley catheter and a metreurynter, for the induction of labor (IOL).
  
  
  METHODS
  A retrospective medical chart review was conducted, focusing on the occurrence of UCP and UCD in 800 women who underwent IOL with a TCBC at five hospitals during the study period (2008-2009 for two hospitals and 2006-2009 for three hospitals). The five hospitals had a total of 8245 deliveries during the study period. UCP and UCD were defined as the descent of the umbilical cord in advance of the presenting fetal part in the presence and absence of rupture of fetal membranes, respectively.
  
  
  RESULTS
  The frequency of IOL using a TCBC with 70-250 mL of saline varied among the five hospitals from 4.9% to 18.8% (mean ± SD, 10.7 ± 5.0%). UCP and UCD occurred in two and four women, respectively, with the frequency of cord presentation varying among the hospitals from 0.0% to 1.8% (mean ± SD, 0.9 ± 0.9%); the cord presentation was significantly more likely to occur when 180-250 mL of saline was used, compared with when 70-150 mL of saline was used (8.2% [5/61] vs 0.15% [1/662], P < 0.0001). A change in the presenting fetal body part also occurred in 0.5% (4/800) of the women.
  
  
  CONCLUSIONS
  The use of a TCBC with 180-250 mL of saline increases the risk of cord presentation.
authors.affiliation: Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan. yamataka@med.hokudai.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamada
authors.forename: Soromon
authors.initials: S
authors.lastname: Kataoka
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Takeda
authors.forename: Takashi
authors.initials: T
authors.lastname: Kojima
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamada
authors.forename: Mamoru
authors.initials: M
authors.lastname: Morikawa
authors.forename: Katsuya
authors.initials: K
authors.lastname: Tsuda
authors.forename: Kaoru
authors.initials: K
authors.lastname: Hanatani
authors.forename: Tatsumi
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Hisanori
authors.initials: H
authors.lastname: Minakami
mesh_terms: D057785:Catheters / Q000009:adverse effects*; D020070:Cervical Ripening; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects* / Q000379:methods; D007744:Obstetric Labor Complications / Q000209:etiology*; D011247:Pregnancy; D012189:Retrospective Studies; D014470:Umbilical Cord