Cord complications: associated risk factors and perinatal outcome

Objective: To assess the perinatal outcome in patients with cord presentation and cord prolapse over a period of 2 years and to assess the obstetric risk factors associated with these cord complications. Design: Retrospective case study. Setting: A tertiary health care centre of India. Sample: All cases of cord presentation and cord prolapse diagnosed in the department over a period of 2 years (2009-2010). Methods: The information regarding maternal presentation at the time of admission, mode of delivery, and neonatal outcome was retrieved from case sheets of patients available in Medical Record Department. Maternal factors in terms of age, parity, gestational age, mode of presentation, mode of delivery were analysed. Foetal outcome was assessed by Diagnosis to Delivery Interval, APGAR score at 0 minutes and 5 minutes, foetal weight and need for NICU admission. Results: There were 53 cases of cord complications, out of which 7 (13.20%) had cord presentation and 46 (86.80%) had cord prolapse. Among these 46 patients, 11 patients developed cord prolapse in labour room (3 after artificial rupture of membranes and 8 after spontaneous rupture of membranes), rest 34 patients presented in emergency with cord prolapse. There were 79.24% multiparous patients, 16 patients had malpresentations and breech was commonest malpresentation. Forty one patients had positive cord pulsations at the time of admission, all these patients underwent emergency caesarean section and all had live babies. Twelve patients reported to us with absent cord pulsation, 3 among these underwent section for obstructed labour with hand and cord prolapse, rest 9 delivered vaginally. The average DDI was 26.00 minutes, DDI in patients developed cord prolapse in hospital was 18.90 minutes ± 5.48 minutes, whereas in patients admitted with cord prolapse as emergency, the DDI was 29.34 minutes ± 6.37 minutes (p < 0.05). Conclusion: Analysis of the study concluded that the delivery interval between cord prolapse and delivery of the foetus is very important. Shortening of this interval can decrease neonatal complication at birth and reduce NICU admission.