(1116) Diagnosis-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse emergencies

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: We aim to investigate whether the diagnosis-to-delivery interval of cord prolapse, stratified according to fetal heart rate (FHR) monitoring at diagnosis was correlated with neonatal outcome.

Study Design: Retrospective study conducted at a high-volume tertiary obstetric center. All women with deliveries complicated by intrapartum cord prolapse between 2008 and 2021 were included. Women were categorized into 3 groups according to FHR monitoring during the acute event - 1) Bradycardia; 2): Decelerations without bradycardia; and 3) Reassuring FHR. Primary outcome measure was defined as arterial cord blood gas indices. Correlation analysis between cord arterial blood gas results and time intervals including diagnosis-to-delivery were performed using the Spearman test.

Results: Overall, 103,917 births occurred during the study period, of which 130 intrapartum umbilical cord prolapse events were identified (0.13%). There were 22 (16.92%), 41(31.53%) and 67 (51.53%) women in groups 1, 2, and 3, respectively. The overall median diagnosis-to-delivery interval was 11.0 minutes (IQR 9.0-15.0 minutes). The overall median cord arterial pH was 7.28 (IQR 7.24-7.32) and less than 7.2 in 4 cases (7.14, 7.18, 7.18, 6.99). Diagnosis-to-delivery interval was over 20 minutes in 4 cases (21, 21, 28, and 31 minutes). Arterial cord pH did not correlate with diagnosis-to-delivery interval (Spearman’s ρ = −.113; p = .0.368) nor with FHR groups (Spearman’s ρ=.425; p=.079, ρ=−.205; p=.336, ρ=−.324; p=.122, respectively). No severe perinatal outcomes were recorded.

Conclusion:

Intrapartum umbilical cord prolapse is an obstetric emergency with overall favorable neonatal outcomes, if managed in a timely manner, regardless of the immediately preceding FHR. No significant correlation between diagnosis-to-delivery interval and arterial cord pH is evident in cases of cord prolapse occurring at a high-volume obstetric unit with a generally rapid, protocol-based, response.

Primary & Presenting Author(s)

Ohad Houri, MD (he/him/his)
Doctor
Rabin Medical Center
Tel Aviv, Israel, Israel

Coauthor(s)

AW
Asnat Walfisch, MD
Hadassah Mount Scopus
Jerusalem, Yerushalayim, Israel
AS
Adi Shilony, MD
Rabin Medical Center
Tel Aviv, HaMerkaz, Israel
Hadas Zafrir danieli, MD
Resident
Rabin Medical Center
Petach Tikva, HaMerkaz, Israel
Ronnie Cohen, MD
dr.
Mayanei Hayeshua Medical Center
Petach Tikva, HaMerkaz, Israel
YG
Yossi Geron, BSc, MD
Rabin Medical Center
Petach Tikva, HaMerkaz, Israel
RM
Ran Matot, BSc, MD
Helen Schneider Hospital for Women, Rabin Medical Center
Petach Tikva, HaMerkaz, Israel
cR
chen Rony, MD
head of labor and delivery department
Rabin Medical Center
Petach Tikva, HaMerkaz, Israel