Umbilical cord prolapse--changing patterns and improved outcomes: a retrospective cohort study.

OBJECTIVE

Umbilical cord prolapse is an acute obstetrical emergency requiring rapid identification and intervention. Its management has undergone significant changes over the past century. This study aims to document the changes in incidence, morbidity, and perinatal mortality over a 69-year period.

DESIGN

A retrospective review of the annual clinical reports of the National Maternity Hospital, Dublin, Ireland, was performed.

SETTING

The National Maternity hospital was founded in 1894 and has nearly 10,000 deliveries each year.

POPULATION

All deliveries in the hospital for each year are included in each annual report.

METHODS

We reviewed the reports from a 69-year period (1940-2009). Information from the reports was collated into a database and analysed using Microsoft excel 2007.

MAIN OUTCOME MEASURES

Incidence and outcome of all cases of umbilical cord prolapse were recorded, along with the neurological outcome of all neonatal survivors (available since 1970).

RESULTS

The incidence of cord prolapse has decreased from 6.4/1000 live births in the 1940s to 1.7/1000 [corrected] live births in the last decade. Perinatal survival increased from 46 to 94% in the same period of time. This is inversely related to the use of caesarean section as the recommended method of delivery in this emergency. Short- and long-term neurological impairment remains rare.

CONCLUSIONS

There has been a large reduction in the incidence of cord prolapse over a period of 69 years. A reduction in grand multiparity and use of caesarean section as the gold standard for delivery are likely to have accounted for the changes seen. Neurological impairment remains unusual.