title: Clinical risk factors for poor neonatal outcomes in umbilical cord prolapse.
abstract: OBJECTIVE
  To clarify the clinical risk factors associated with poor neonatal outcomes due to umbilical cord prolapse (UCP).
  
  
  METHODS
  A postal questionnaire survey was attempted in Japan. The clinical risk factors and managements associated with poor neonatal outcomes were analyzed in cases of UCP treated in Japan.
  
  
  RESULTS
  A total of 267 cases of UCP (out of 2 037 460 total deliveries) were analyzed. The rates of intrauterine death, neonatal death and survival with disability were 3.4%, 5.6% and 7.1%, respectively. The multivariate regression analysis for these poor neonatal outcomes revealed that the significant risk factors included a prolapsed amniotic sac (adjusted odds ratio (aOR), 4.49), preterm labor (aOR, 2.99) and replacement of the prolapsed umbilical cord into the uterus (aOR, 2.87). However, UCP that occurred during labor (aOR, 0.28) and emergency cesarean section (aOR, 0.11) were associated with a reduction in the rates of poor outcomes. The interval between the diagnosis of UCP and delivery was significantly longer in the infants with a poor outcome than intact survival (median 30 versus 24 min, p = 0.048).
  
  
  CONCLUSIONS
  An emergency cesarean section should be carried out immediately to ensure a better outcome for the infant.
authors.affiliation: a Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan .
authors.forename: Junichi
authors.initials: J
authors.lastname: Hasegawa
authors.affiliation: a Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan .
authors.forename: Akihiko
authors.initials: A
authors.lastname: Sekizawa
authors.affiliation: b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan .
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: c Kawakita General Hospital , Tokyo , Japan .
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Koresawa
authors.affiliation: d Ishiwata Obstetrics and Gynecology Hospital , Ibaraki , Japan .
authors.forename: Isamu
authors.initials: I
authors.lastname: Ishiwata
authors.affiliation: e Doai Memorial Hospital , Tokyo , Japan , and.
authors.forename: Masakiyo
authors.initials: M
authors.lastname: Kawabata
authors.affiliation: f Seijo-Kinoshita Hospital , Tokyo , Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007564:Japan; D066087:Perinatal Death; D011247:Pregnancy; D011391:Prolapse; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014470:Umbilical Cord
keywords: Cerebral palsy; emergency cesarean section; fetal death; fore-lying cord; umbilical cord prolapse