Emergency obstetrics care in a Nigerian tertiary hospital: a 20 year review of umblical cord prolapse.

Background: Umbilical cord prolapse is an obstetric emergency associated with high perinatal morbidity and mortality unless prompt delivery by the fastest and safest route is carried out.

Objective: To determine the incidence of umbilical cord prolapse, predisposing factors, and fetal outcome.

Methods: A 20 year retrospective study of all women who presented with umbilical cord prolapse at University of Maiduguri Teaching Hospital, Maiduguri, North-Eastern Nigeria.

Results: During the study period there were 27,753 deliveries and 75 women had cord prolapse, giving the incidence of 1 in 370 deliveries (0.27%). Significantly more patients with non vertex presentation, twins and preterm delivery had cord prolapse. The highest occurrence was in those with unengaged presenting part (65.2%), spontaneous rupture of membrances (62.1%) and grandmultiparous women (57.6%). Caeserean section was carried out in 50% of cases, with mean decision-delivery interval of 77.1 +/- 21.7 minutes and 28/33 (84.9%) of babies delivered within 60 minute had normal Apgar scores. The Knee-chest position was most commonly used method of alleviating cord compression while arrangement for caesarean section was being made. The perinatal mortality was 27.3%.

Conclusions: umbilical cord prolapse is a brisk obstetric emergency with high perinatal morbidity and mortality unless prompt delivery is undertaken. Better communication and prompt response to emergency by the theatre team to reduce the decision-delivery interval would improve the perinatal outcome.