so as problems in pregnancy and birth go cord prolapse is a very small number but is most common cord accident--- keeping with the topic- and my statement included "preterm" as a risk factor for prolapse
Int J Gynaecol Obstet. 2004 Feb;84(2):127-32.
Umbilical cord prolapse and perinatal outcomes.
Kahana B, Sheiner E, Levy A, Lazer S, Mazor M.
Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
OBJECTIVES: To determine obstetric risk factors and perinatal outcomes of pregnancies complicated by umbilical cord prolapse. METHODS: A population-based study was performed comparing all deliveries complicated by cord prolapse to deliveries without this complication. Statistical analysis was performed using multiple logistic regression models. RESULTS: Prolapse of the umbilical cord complicated 0.4% (n=456) of all deliveries included in the study (n=121,227). Independent risk factors for cord prolapse identified by a backward, stepwise multivariate logistic regression model were: malpresentation (OR=5.1; 95% CI 4.1-6.3), hydramnios (OR=3.0; 95% CI 2.3-3.9), true knot of the umbilical cord (OR=3.0; 95% CI 1.8-5.1), preterm delivery (OR=2.1; 95% CI 1.6-2.8), induction of labor (OR=2.2; 95% CI 1.7-2.8), grandmultiparity (>five deliveries, OR=1.9; 95% CI 1.5-2.3), lack of prenatal care (OR=1.4; 95% CI 1.02-1.8), and male gender (OR=1.3; 95% CI 1.1-1.6). Newborns delivered after umbilical cord prolapse graded lower Apgar scores, less than 7, at 5 min (OR=11.9, 95% CI 7.9-17.9), and had longer hospitalizations (mean 5.4+/-3.5 days vs. 2.9+/-2.1 days; P<0.001). Moreover, higher rates of perinatal mortality were noted in the cord prolapse group vs. the control group (OR=6.4, 95% CI 4.5-9.0). Using a multiple logistic regression model controlling for possible confounders, such as preterm delivery, hydramnios, etc., umbilical cord prolapse was found to be an independent contributing factor to perinatal mortality. CONCLUSIONS: Prolapse of the umbilical cord is an independent risk factor for perinatal mortality.
Eur J Obstet Gynecol Reprod Biol. 1983 Apr;15(1):17-23.
Neonatal mortality and morbidity associated with preterm breech presentation.
van Eyk EA, Huisjes HJ.
A retrospective study was performed on 88 live-born preterm infants with breech presentation. The neonatal mortality (NNM) was 18.2%, and 13.3% after correction for congenital malformations incompatible with life. 62.5% were delivered vaginally, and 37.5% by cesarean section (CS). In spite of the fact that most CSs were done for indications associated with increased fetal and neonatal morbidity and mortality, overall morbidity was comparable in the two groups. Mortality was higher in the vaginal group. Entrapment of the fetal head (7.3% of vaginal deliveries) and prolapse of the cord (4.5%) were major complications of preterm breech delivery. They resulted in two cases of neonatal death (NND) and three cases of neonatal asphyxia. Prolapse of the cord was in all cases associated with footling presentation. The authors consider these results in favor of routine CS in preterm breech presentation
now I think that after their statement of one maternal incident!!!!!!!! I don't exactly agree with their conclusion of c-sectioning breeches
J Obstet Gynaecol. 2004 Apr;24(3):254-8.
Related Articles, Links
Correlation of fetal outcome with mode of delivery for breech presentation.
Bassaw B, Rampersad N, Roopnarinesingh S, Sirjusingh A.
Department of Obstetrics and Gynaecology, University of the West Indies, Trinidad. firstname.lastname@example.org
The objective of this retrospective analysis of 344 singleton pregnancies of gestational ages greater than 24 weeks conducted at a tertiary hospital was to determine the fetal outcome in relation to the mode of delivery of the fetus with a breech presentation. Caesarean section was performed in 157 mothers, and 187 babies were delivered vaginally. There was no statistical difference in the perinatal outcome for breech fetuses delivered either abdominally or vaginally. Cord prolapse and arrest of the after-coming head were responsible for five fetal losses, four of which were delivered vaginally. Neonatal morbidity comprising nerve injury, birth asphyxia and seizures occurred in 11 newborns, nine of whom were delivered vaginally. One mother sustained a massive intra-operative haemorrhage during a caesarean section which necessitated an emergency hysterectomy. We conclude that a policy of planned vaginal birth for selected breech fetuses with a low threshold to proceed to caesarean section may be in the best interests of both mother and child.