Prolapse and presentation of the umbilical cord.

The outcome of pregnancies with prolapse and presentation of the umbilical cord at Tsan Yuk Hospital, Hong Kong, 1976 to 1982, was reviewed. The incidence was 0.17%, 70 of 41,939 deliveries; 98% of cases were diagnosed in hospital. Breech presentation, low birth-weight and artificial rupture of membranes were found to be significant associations; 78% of cases were discovered by vaginal examination and the diagnosis-delivery interval was less than 30 minutes in 75%. There were 8 perinatal deaths and 3 of these occurred in babies whose birth-weights were less than 1,000 g; 2 stillbirths were associated with presentation of the cord. The corrected perinatal mortality was 8.6% with a corresponding Caesarean section rate of 73.3%. 80% of the babies born by Caesarean section had 5 minutes Apgar scores of 7 or more. It was concluded that early diagnosis of umbilical cord prolapse followed by prompt treatment are effective in reducing the perinatal mortality rate. Energetic intrapartum monitoring is also essential in order that patients with occult prolapse or presentation of the umbilical cord be diagnosed early and treated promptly.