Paper Title
EVALUATION OF RISK FACTORS AND PERINATAL OUTCOME OF UMBILICAL CORD PROLAPSE DURING LABOR

Abstract
Abstract - Introduction - Umbilical cord prolapse is an obstetric emergency which can convert an uneventful ongoing normal pregnancy to a sudden emergency. The incidence of cord prolapse has been reported to be 0.1 to 0.6% worldwide. Polyhydramnios, noncephalic presentation, abnormal lie, multiparity, prematurity, are at higher risk of cord prolapse. But, in modern obstetric practice, singleton term pregnancies with cephalic presentation and spontaneous rupture of membrane are risk factors for umbilical cord prolapse. Early identification and intervention in the form of emergency LSCS facility and NICU care might help in improving neonatal outcome Objectives - To understand the maternal risk factors and neonatal outcomes of pregnancy complicated by umbilical cord prolapse Methodology - Study Design & Study Population: Prospective observational study among the deliveries with cord prolapse conducted at Labour room / Operation theatres of Department of OBG at Basaveshwara Hospital, Chitradurga. Study was conducted for 02 years from 1st March 2022 to 28th February 2023. Study Procedure - During study period, 30 cases of umbilical cord prolapse were detected. Those cases where umbilical cord was felt vaginally or seen prolapsed out of the introitus were considered as umbilical cord prolapse and included as the subjects.The following clinical and demographic data were obtained by reviewing the patients’ medical records: Maternal age, obstetric history, complications in the current pregnancy, stage of labor at delivery, diagnosis to delivery interval, neonatal APGAR scores at 1st and 5th minute. Statistical Analysis - Data compiled in MS Excel spreadsheet & Analyzed with SPSS software v:16.0., All characteristics were summarized descriptively. Continuous variables summarized as N, mean, standard deviation(SD) . Categorical data is summarized in number/frequency and percentages.To test significance of associations,Chi square test (categorical variables), Independent student t’ test (continuous variables) were applied. Results - 73% of cord prolapse cases were among females aged <25 years, 64% of cord prolapse cases were among multigravida cases. 73% were singleton pregnancies, 27% were twin pregnancies. 70% of cases had cephalic presentation, 20% had transverse and 10% had breech presentations. LSCS was done for 94% of cord prolapse cases. 6% of cases delivered vaginally. 85% of cases had <30 minutes decision to delivery interval. 43% of delivered newborns had <2.5kg birth weight. <7 APGAR score at 1 minute was present in 35% babies. >7 APGAR score was present at 5 minutes in 81% of babies whereas <7 APGAR score was present at 5 minutes in 19% of babies Cord prolapse was found to be in higher among cases of multiparity (66.7%), pre-term deliveries (33.3%), cephalopelvic disproportions (29.3%), transverse lie(20%), polyhydramnios (13.3%) and breech presentations (10%) Discussion - The incidence of umbilical cord prolapse in our hospital was 0.1%. In the present study, higher percentage of multiparty, singleton pregnancy and cephalic presentation pregnancies were associated with umbilical cord prolapse . Risk of preterm delivery and parity increases in patients with advanced maternal age.Polyhydramnios has been linked to umbilical cord prolapse. Spontaneous rupture of membranes may increase the risk of cord prolapse. Multiparity, non vertex fetal presentation and cephalopelvic disproportion were also associated with increased risk of umbilical cord prolapse during labor. Emergency cesarean delivery is the rule following recognition of cord prolapse. Conclusion - Umbilical cord prolapse is a rare complication that is more common in preterm deliveries, multiparity, nonvertex fetal presentation, and spontaneous rupture of membranes with unengaged fetal head. Early detection and intervention is required for good neonatal outcome. Umbilical cord prolapse should be managed by an expert obstetrician Keywords - Cord Prolapse, Parity, Neonatal Outcome, Rupture of Membrane, Preterm, LSCS