Umbilical cord prolapse and perinatal outcomes

Kahana, B.; Sheiner, E.; Levy, A.; Lazer, S.; Mazor, M.

doi:10.1016/S0020-7292(03)00333-3

« Previous Next »International Journal of Gynecology & Obstetrics
Volume 84, Issue 2 , Pages 127-132, February 2004

Umbilical cord prolapse and perinatal outcomes☆

B. Kahana
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
E. Sheiner
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Corresponding author. Tel.: +972-8-640-3524; fax: +-972-8-690-0623
A. Levy
- Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
S. Lazer
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
M. Mazor
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Received 8 April 2003; received in revised form 16 July 2003; accepted 16 July 2003.

Abstract

Objectives: To determine obstetric risk factors and perinatal outcomes of pregnancies complicated by umbilical cord prolapse. Methods: A population-based study was performed comparing all deliveries complicated by cord prolapse to deliveries without this complication. Statistical analysis was performed using multiple logistic regression models. Results: Prolapse of the umbilical cord complicated 0.4% (n=456) of all deliveries included in the study (n=121227). Independent risk factors for cord prolapse identified by a backward, stepwise multivariate logistic regression model were: malpresentation (OR=5.1; 95% CI 4.1–6.3), hydramnios (OR=3.0; 95% CI 2.3–3.9), true knot of the umbilical cord (OR=3.0; 95% CI 1.8–5.1), preterm delivery (OR=2.1; 95% CI 1.6–2.8), induction of labor (OR=2.2; 95% CI 1.7–2.8), grandmultiparity (>five deliveries, OR=1.9; 95% CI 1.5–2.3), lack of prenatal care (OR=1.4; 95% CI 1.02–1.8), and male gender (OR=1.3; 95% CI 1.1–1.6). Newborns delivered after umbilical cord prolapse graded lower Apgar scores, less than 7, at 5 min (OR=11.9, 95% CI 7.9–17.9), and had longer hospitalizations (mean 5.4±3.5 days vs. 2.9±2.1 days; P<0.001). Moreover, higher rates of perinatal mortality were noted in the cord prolapse group vs. the control group (OR=6.4, 95% CI 4.5–9.0). Using a multiple logistic regression model controlling for possible confounders, such as preterm delivery, hydramnios, etc., umbilical cord prolapse was found to be an independent contributing factor to perinatal mortality. Conclusions: Prolapse of the umbilical cord is an independent risk factor for perinatal mortality.