Fetal demise and associated factors following umbilical cord prolapse in Mulago hospital, Uganda: a retrospective study.
BACKGROUND
Umbilical cord prolapse is an obstetric complication associated with high perinatal morbidity and mortality. A few interventions may improve fetal outcome. In developed countries these have advanced to giving intrauterine fetal resuscitation. Conditions in low resource settings do not allow for some of these advanced techniques. Putting the mother in knee chest position and immediate delivery may be the only options possible.We set out to determine the incidence of fetal demise and associated factors following umbilical cord prolapsed (UCP) in Mulago Hospital, Uganda.


METHODS
In a retrospective study conducted in Mulago hospital, Uganda, file records of mothers who delivered between 1st January 2000 to 31st December 2009 and had pregnancies complicated by umbilical cord prolapse with live fetus were selected. We collected information on referral status, cord position, cervical dilatation, fetal heart state at the time of diagnosis of UCP, diagnosis to delivery interval, use of knee chest position, mode of delivery, birth weight and fetal outcome.We computed incidence of fetal demise following UCP and determined factors associated with fetal demise in pregnancies complicated by UCP.


RESULTS
Of 438 cases with prolapsed cord, 101(23%) lost their babies within 24 hours after birth or were delivered dead. This gave annual cumulative incidence of fetal death following UCP of 23/1000 live UCP cases delivered /year.The major factors associated with fetal outcome in pregnancies complicated by UCP included; diagnosis to delivery interval <30 min, RR 0.79 (CI 0.74-0.85), mode of delivery, RR 1.14 (CI 1.02-1.28), knee chest position, RR 0.81 (CI 0.70-0.95).


CONCLUSIONS
The annual cumulative incidence of fetal death in our study was 23/1000 live UCP cases delivery per year for the period of 10 years studied. Cesarean section reduced perinatal mortality by a factor of 2. Diagnosis to delivery interval <30 minutes and putting mother in knee chest position were protective against fetal death.
Esau Wangi
EW
Wasswa
Sarah
S
Nakubulwa
Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda. tmutyaba@yahoo.com.
Twaha
T
Mutyaba
D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005313:Fetal Death / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology* / Q000503:physiopathology; D011256:Pregnancy Outcome; D011391:Prolapse; D012189:Retrospective Studies; D014454:Uganda; D014470:Umbilical Cord / Q000473:pathology* / Q000503:physiopathology