Audit of Cord Prolapse Management at King Abdulaziz University Hospital

To assess the incidence of risk factors, management and outcome of umbilical cord prolapsed in a university hospital setting. A retrospective chart review of women who had cord prolapsed at King Abdulaziz University Hospital over a period of eight years. During the study period there were 49 cases of cord prolapsed (0.15% incidence), which includes seven cases of cord presentation. The mean maternal age was 30.31 years. The majority was booked cases (71.4%) and 5 were less than gravida (73.5%). In 10.2% labor was induced. The incidence of abnormal fetal presentation was 16%, and in six patients the onset of labor was before 31 weeks. The mean diagnosis to delivery interval was approximately 23 minutes; with the exception of two vaginal deliveries and one ventouse delivery, all women underwent crash cesarean delivery. There were 11 admissions to the NICU/SCBU and four mortalities, giving an overall perinatal mortality of 8.15%. In two of the mortality cases there were potentially avoidable factors; the remaining ones were extremely premature babies. Cord prolapsed is still a serious obstetric emergency. The diagnosis to delivery interval is a crucial factor in the management of cord prolapsed. All obstetric units should maintain continuous drills on crash cesarean deliveries.