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Decision-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse

BACKGROUND: Rapid delivery is important in cases of umbilical cord prolapse to prevent hypoxic injury to the fetus/neonate. However, the optimal decision-to-delivery interval remains controversial. OBJECTIVE: The aim of the study was to investigate the association between the decision-to-delivery in...

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Autores principales: Houri, Ohad, Walfisch, Asnat, Shilony, Adi, Zafrir-Danieli, Hadas, Hendin, Natav, Matot, Ran, Navon, Inbal, Hadar, Eran
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288770/
https://www.ncbi.nlm.nih.gov/pubmed/37349738
http://dx.doi.org/10.1186/s12884-023-05788-y
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author Houri, Ohad
Walfisch, Asnat
Shilony, Adi
Zafrir-Danieli, Hadas
Hendin, Natav
Matot, Ran
Navon, Inbal
Hadar, Eran
author_facet Houri, Ohad
Walfisch, Asnat
Shilony, Adi
Zafrir-Danieli, Hadas
Hendin, Natav
Matot, Ran
Navon, Inbal
Hadar, Eran
author_sort Houri, Ohad
collection PubMed
description BACKGROUND: Rapid delivery is important in cases of umbilical cord prolapse to prevent hypoxic injury to the fetus/neonate. However, the optimal decision-to-delivery interval remains controversial. OBJECTIVE: The aim of the study was to investigate the association between the decision-to-delivery interval in women with umbilical cord prolapse, stratified by fetal heart rate pattern at diagnosis, and neonatal outcome. STUDY DESIGN: The database of a tertiary medical center was retrospectively searched for all cases of intrapartum cord prolapse between 2008 and 2021. The cohort was divided into three groups according to findings on the fetal heart tracing at diagnosis: 1) bradycardia; 2) decelerations without bradycardia; and 3) reassuring heart rate. The primary outcome measure was fetal acidosis. The correlation between cord blood indices and decision-to-delivery interval was analyzed using Spearman’s rank correlation coefficient. RESULTS: Of the total 103,917 deliveries performed during the study period, 130 (0.13%) were complicated by intrapartum umbilical cord prolapse. Division by fetal heart tracing yielded 22 women (16.92%) in group 1, 41 (31.53%) in group 2, and 67 (51.53%) in group 3. The median decision-to-delivery interval was 11.0 min (IQR 9.0–15.0); the interval was more than 20 min in 4 cases. The median cord arterial blood pH was 7.28 (IQR 7.24–7.32); pH was less than 7.2 in 4 neonates. There was no correlation of cord arterial pH with decision-to-delivery interval (Spearman’s Ρ =  − 0.113; Ρ = 0.368) or with fetal heart rate pattern (Spearman’s Ρ = .425; Ρ = .079, Ρ =  − .205; Ρ = .336, Ρ =  − .324; Ρ = .122 for groups 1–3, respectively). CONCLUSION: Intrapartum umbilical cord prolapse is a relatively rare obstetric emergency with an overall favorable neonatal outcome if managed in a timely manner, regardless of the immediately preceding fetal heart rate. In a clinical setting which includes a high obstetric volume and a rapid, protocol-based, response, there is apparently no significant correlation between decision-to-delivery interval and cord arterial cord pH. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-023-05788-y.
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spelling pubmed-102887702023-06-24 Decision-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse Houri, Ohad Walfisch, Asnat Shilony, Adi Zafrir-Danieli, Hadas Hendin, Natav Matot, Ran Navon, Inbal Hadar, Eran BMC Pregnancy Childbirth Research BACKGROUND: Rapid delivery is important in cases of umbilical cord prolapse to prevent hypoxic injury to the fetus/neonate. However, the optimal decision-to-delivery interval remains controversial. OBJECTIVE: The aim of the study was to investigate the association between the decision-to-delivery interval in women with umbilical cord prolapse, stratified by fetal heart rate pattern at diagnosis, and neonatal outcome. STUDY DESIGN: The database of a tertiary medical center was retrospectively searched for all cases of intrapartum cord prolapse between 2008 and 2021. The cohort was divided into three groups according to findings on the fetal heart tracing at diagnosis: 1) bradycardia; 2) decelerations without bradycardia; and 3) reassuring heart rate. The primary outcome measure was fetal acidosis. The correlation between cord blood indices and decision-to-delivery interval was analyzed using Spearman’s rank correlation coefficient. RESULTS: Of the total 103,917 deliveries performed during the study period, 130 (0.13%) were complicated by intrapartum umbilical cord prolapse. Division by fetal heart tracing yielded 22 women (16.92%) in group 1, 41 (31.53%) in group 2, and 67 (51.53%) in group 3. The median decision-to-delivery interval was 11.0 min (IQR 9.0–15.0); the interval was more than 20 min in 4 cases. The median cord arterial blood pH was 7.28 (IQR 7.24–7.32); pH was less than 7.2 in 4 neonates. There was no correlation of cord arterial pH with decision-to-delivery interval (Spearman’s Ρ =  − 0.113; Ρ = 0.368) or with fetal heart rate pattern (Spearman’s Ρ = .425; Ρ = .079, Ρ =  − .205; Ρ = .336, Ρ =  − .324; Ρ = .122 for groups 1–3, respectively). CONCLUSION: Intrapartum umbilical cord prolapse is a relatively rare obstetric emergency with an overall favorable neonatal outcome if managed in a timely manner, regardless of the immediately preceding fetal heart rate. In a clinical setting which includes a high obstetric volume and a rapid, protocol-based, response, there is apparently no significant correlation between decision-to-delivery interval and cord arterial cord pH. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-023-05788-y. BioMed Central 2023-06-22 /pmc/articles/PMC10288770/ /pubmed/37349738 http://dx.doi.org/10.1186/s12884-023-05788-y Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Houri, Ohad
Walfisch, Asnat
Shilony, Adi
Zafrir-Danieli, Hadas
Hendin, Natav
Matot, Ran
Navon, Inbal
Hadar, Eran
Decision-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse
title Decision-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse
title_full Decision-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse
title_fullStr Decision-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse
title_full_unstemmed Decision-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse
title_short Decision-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse
title_sort decision-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288770/
https://www.ncbi.nlm.nih.gov/pubmed/37349738
http://dx.doi.org/10.1186/s12884-023-05788-y
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