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      Fetal demise and associated factors following umbilical cord prolapse in Mulago hospital, Uganda: a retrospective study

      research-article
      1 , 1 , 1 ,
      Reproductive Health
      BioMed Central
      Fetal demise, Umbilical cord prolapse, Uganda

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          Abstract

          Background

          Umbilical cord prolapse is an obstetric complication associated with high perinatal morbidity and mortality. A few interventions may improve fetal outcome. In developed countries these have advanced to giving intrauterine fetal resuscitation. Conditions in low resource settings do not allow for some of these advanced techniques. Putting the mother in knee chest position and immediate delivery may be the only options possible.

          We set out to determine the incidence of fetal demise and associated factors following umbilical cord prolapsed (UCP) in Mulago Hospital, Uganda.

          Methods

          In a retrospective study conducted in Mulago hospital, Uganda, file records of mothers who delivered between 1 st January 2000 to 31 st December 2009 and had pregnancies complicated by umbilical cord prolapse with live fetus were selected. We collected information on referral status, cord position, cervical dilatation, fetal heart state at the time of diagnosis of UCP, diagnosis to delivery interval, use of knee chest position, mode of delivery, birth weight and fetal outcome.

          We computed incidence of fetal demise following UCP and determined factors associated with fetal demise in pregnancies complicated by UCP.

          Results

          Of 438 cases with prolapsed cord, 101(23%) lost their babies within 24 hours after birth or were delivered dead. This gave annual cumulative incidence of fetal death following UCP of 23/1000 live UCP cases delivered /year.

          The major factors associated with fetal outcome in pregnancies complicated by UCP included; diagnosis to delivery interval <30 min, RR 0.79 (CI 0.74-0.85), mode of delivery, RR 1.14 (CI 1.02-1.28), knee chest position, RR 0.81 (CI 0.70-0.95).

          Conclusions

          The annual cumulative incidence of fetal death in our study was 23/1000 live UCP cases delivery per year for the period of 10 years studied. Cesarean section reduced perinatal mortality by a factor of 2. Diagnosis to delivery interval <30 minutes and putting mother in knee chest position were protective against fetal death.

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          Most cited references11

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          The mortality and morbidity associated with umbilical cord prolapse.

          To examine the management of cord prolapse and its morbidity and mortality. Retrospective study of consecutive babies born after cord prolapse, identified using the Oxford Obstetric Data System, and those with registered handicap, identified by the Oxford Region Register of Early Childhood Impairments. District maternity hospital managing more than 6000 deliveries annually. One hundred and thirty-two babies born after the identification of cord prolapse in the John Radcliffe Hospital between January 1984 and December 1992. Survival rates, condition at birth assessed by Apgar scores at 1 and 5 minutes and blood gas values on cord blood samples, and incidence of major handicap at three years of age. The incidence of cord prolapse was 1 in 426 total births. There were six stillbirths and six neonatal deaths. One baby died as a result of birth asphyxia. The uncorrected perinatal mortality rate was 91 per 1000. Of 120 survivors, only one baby was known to suffer a major neurological handicap. Electronic cardiotocographs aided the diagnosis of cord prolapse in 41% of cases. Apgar scores were better with a shorter diagnosis to delivery interval, but cord gas results did not correlate well with Apgar scores or the diagnosis to delivery interval. Cord prolapse occurs with a relatively stable incidence in this population irrespective of changes in obstetric practices. Despite the high incidence of ominous cardiotocographs, low Apgar scores and acidaemia on blood gas analysis, the fetal outcome is not as poor as might be expected and mortality is predominantly attributable to congenital anomalies and prematurity rather than birth asphyxia.
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            Umbilical cord prolapse and perinatal outcomes.

            To determine obstetric risk factors and perinatal outcomes of pregnancies complicated by umbilical cord prolapse.
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              Risk factors and infant outcomes associated with umbilical cord prolapse: a population-based case-control study among births in Washington State.

              Our goal was to quantify the magnitude of risk associated with conditions resulting in umbilical cord prolapse and adverse infant outcome after cord prolapse. This population-based case-control study used birth certificate data from 709 cases and 2407 randomly selected controls. Odds ratios were used as measures of association, with stratification performed to control for confounding. Case infants were more likely to weigh < 2500 mg (odds ratio 4.8, 95% confidence interval 3.7 to 6.2) and to born prematurely (odds ratio 2.9, 95% confidence interval 2.2 to 3.7). Other risk factors were breech presentation (birth weight-adjusted odds ratio 2.5, 95% confidence interval 1.7 to 3.9) and being a second-born twin (odds ratio 5.0, 95% confidence interval 3.3 to 11.7). Subsequent adverse infant outcomes included an increased risk of mortality (relative risk 2.7, 95% confidence interval 1.9 to 4.0), with mortality being less likely to occur among cases delivered by cesarean section (relative risk 0.4, 95% confidence interval 0.2 to 0.6). This study confirms previously suspected risk factors and supports clinical management of cord prolapse by cesarean section delivery.
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                Author and article information

                Journal
                Reprod Health
                Reprod Health
                Reproductive Health
                BioMed Central
                1742-4755
                2014
                1 February 2014
                : 11
                : 12
                Affiliations
                [1 ]Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda
                Article
                1742-4755-11-12
                10.1186/1742-4755-11-12
                3911795
                24485199
                0e0d1476-8a79-48c6-9f9f-e745872579ff
                Copyright © 2014 Wasswa et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

                History
                : 26 August 2013
                : 30 January 2014
                Categories
                Research

                Obstetrics & Gynecology
                fetal demise,umbilical cord prolapse,uganda
                Obstetrics & Gynecology
                fetal demise, umbilical cord prolapse, uganda

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