Umbilical cord prolapse in a secondary health center in South Eastern Nigeria: A 20-year experience

Abstract

Introduction: Umbilical cord prolapse is a dire obstetric emergency that causes a lot of fetal morbidity and mortality and maternal morbidity. The incidence in our Center is not known and the outcome of the cases we have been managing in our Center had never been audited before with a view to finding out how to improve on our management. It is against this back drop that this work is carried out. Material and Method: This is a retrospective study involving all the cases of umbilical cord prolapse managed in Mater Misericordiae Hospital, Afikpo, Ebonyi State, Nigeria from January 1995 to December 2014. The case notes were got from the hospital's Records Department and relevant information were retrieved and analyzed. Results: There were 92 cases of cord prolapse and 22,595 deliveries over the period giving an incidence of cord prolapse of 0.41% or one case of cord prolapse in every 246 deliveries. Twenty one or 22.8% had multiple pregnancy. Fifty two women (56.5%) had mal-presentation and 51 (55.4%) of the women had emergency lower segment caesarean section. Fifty (54.3%) of the babies weighed 2.5 Kg or below. Sixty three (65.6%) of the fetuses were alive while 33 (34.4%) had intra-uterine fetal death giving a perinatal mortality rate of 343.8 per 1000 births. There was no maternal mortality. Of the 63 babies delivered alive, 25(40.3%) had apgar scores of 8 to 10, 22(34.9%) 5 to 7 while16 (25.8%) 1 to 4 in one minute. Conclusion: Umbilical cord prolapse in rural Nigeria is a rare but devastating obstetric emergency with a high perinatal mortality rate and maternal morbidity. Obstetricians must continually update their skills in the management of this condition to help reduce its devastating consequences.