Junichi Hasegawa1, Akihiko Sekizawa1, Tomoaki Ikeda2, Mitsuhiko Koresawa3, Isamu Ishiwata4, Masakiyo Kawabata5, Katsuyuki Kinoshita6. 1. a Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan . 2. b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan . 3. c Kawakita General Hospital , Tokyo , Japan . 4. d Ishiwata Obstetrics and Gynecology Hospital , Ibaraki , Japan . 5. e Doai Memorial Hospital , Tokyo , Japan , and. 6. f Seijo-Kinoshita Hospital , Tokyo , Japan.
Abstract
OBJECTIVES: To clarify the clinical risk factors associated with poor neonatal outcomes due to umbilical cord prolapse (UCP). METHODS: A postal questionnaire survey was attempted in Japan. The clinical risk factors and managements associated with poor neonatal outcomes were analyzed in cases of UCP treated in Japan. RESULTS: A total of 267 cases of UCP (out of 2 037 460 total deliveries) were analyzed. The rates of intrauterine death, neonatal death and survival with disability were 3.4%, 5.6% and 7.1%, respectively. The multivariate regression analysis for these poor neonatal outcomes revealed that the significant risk factors included a prolapsed amniotic sac (adjusted odds ratio (aOR), 4.49), preterm labor (aOR, 2.99) and replacement of the prolapsed umbilical cord into the uterus (aOR, 2.87). However, UCP that occurred during labor (aOR, 0.28) and emergency cesarean section (aOR, 0.11) were associated with a reduction in the rates of poor outcomes. The interval between the diagnosis of UCP and delivery was significantly longer in the infants with a poor outcome than intact survival (median 30 versus 24 min, p = 0.048). CONCLUSION: An emergency cesarean section should be carried out immediately to ensure a better outcome for the infant.
OBJECTIVES: To clarify the clinical risk factors associated with poor neonatal outcomes due to umbilical cord prolapse (UCP). METHODS: A postal questionnaire survey was attempted in Japan. The clinical risk factors and managements associated with poor neonatal outcomes were analyzed in cases of UCP treated in Japan. RESULTS: A total of 267 cases of UCP (out of 2 037 460 total deliveries) were analyzed. The rates of intrauterine death, neonatal death and survival with disability were 3.4%, 5.6% and 7.1%, respectively. The multivariate regression analysis for these poor neonatal outcomes revealed that the significant risk factors included a prolapsed amniotic sac (adjusted odds ratio (aOR), 4.49), preterm labor (aOR, 2.99) and replacement of the prolapsed umbilical cord into the uterus (aOR, 2.87). However, UCP that occurred during labor (aOR, 0.28) and emergency cesarean section (aOR, 0.11) were associated with a reduction in the rates of poor outcomes. The interval between the diagnosis of UCP and delivery was significantly longer in the infants with a poor outcome than intact survival (median 30 versus 24 min, p = 0.048). CONCLUSION: An emergency cesarean section should be carried out immediately to ensure a better outcome for the infant.