A 6-Year Review of Cord Prolapse in a Tertiary Health Facility in Bayelsa State

Abstract

Background: Prolapse of the umbilical cord remains a life threatening obstetric emergency for the fetus. This study sought to evaluate the prevalence, associated factors, and outcomes of cord prolapse in Niger Delta University Teaching Hospital (NDUTH), Okolobiri, Nigeria. Methodology: In a retrospective, descriptive, cross sectional study design, cases managed for cord prolapse between January 2012 and December 2017 were audited using a self-developed proforma. Data collected include sociodemographic information, obstetric history, antenatal care in the index pregnancy, associated factors, management and outcome (morbidity and mortality) of cord prolapse in the centre. Results: Of the 3172 deliveries that occurred during the 6year period of study, 22 deliveries were complicated by cord prolapse, affecting 6 in 1000 live birth in the centre. Unbooked status (72.7%), malpresentation (72.7%), multiparity (45.5%), prematurity (45.5%), and abnormal lie (45.5%) were identified associated factors among the parturients. Other associated factors seen were polyhydramnious, abdominal massage in pregnancy and twin gestation. The perinatal mortality due to cord prolapse was 1.6 per 1000 live births. All the babies with umbilical cord pulsation had immediate delivery by caesarean section. A Diagnosis-Delivery interval (DDI) < 30minutes was associated with better neonatal outcome and babies delivered within this time frame all required no admission into the SCBU. Conclusion: In this study umbilical cord prolapse was associated with increased perinatal morbidity and mortality, especially amongst unbooked patients. The major associated factors identified were unbooked status, malpresentation, multiparity, prematurity and abnormal lie. A substantial number of parturients with cord prolapse had a history of culturally based abdominal massage in pregnancy prior to presentation. The possible aetiological contribution of this culturally based practice, with respect to cord prolapse needs further investigation.