Labor induction by transcervical balloon catheter and cerebral palsy associated with umbilical cord prolapse

Abstract Background The aim of the present study was to clarify the evolution of the fetal heart rate (FHR) patterns in infants with cerebral palsy (CP) according to each type of umbilical cord trouble. Methods A case-control study was attempted in the subjects born from 2009 to 2014 and those with a birth weight of > 2000 g, gestational age of > 33 weeks, and disability due to CP, CP associated with (126 cases) and without (594 controls) umbilical cord troubles were compared. Results Therty-two were umbilical cord prolapse and 94 were other umbilical cord troubles coexisting antenatally. Abnormal FHR patterns had already been identified on admission in 13% of cases with umbilical cord prolapse and 40% of cases with cord trouble coexisting antenatally. A persistent non-reassuring pattern was significantly frequent in cases with cord trouble coexisting antenatally (p = 0.012) and less frequent in cases with umbilical cord prolapse (p = 0.003). Reactive-PD was significantly identified in 69% of the cases with umbilical cord prolapse and 35% of the cases with cord trouble coexisting antenatally, especially in the first stage of labor (p < 0.001). Conclusion Persistent non-reassuring patterns on admission and reactive-PD pattern during the 1st stage of labor were characterized in infants with CP related to umbilical cord troubles coexisting antenatally.

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Faculty Opinions recommendation of Emergency Cesarean delivery for umbilical cord prolapse: the head-down, knee-chest prone position for spinal anesthesia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1161580.623135 ◽

2009 ◽

Author(s):

Bernard Wittels

Keyword(s):

Spinal Anesthesia ◽

Cesarean Delivery ◽

Prone Position ◽

Umbilical Cord ◽

Emergency Cesarean ◽

Cord Prolapse ◽

Umbilical Cord Prolapse

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Evaluation of the risk of umbilical cord prolapse in the second twin during vaginal delivery: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-046616 ◽

2021 ◽

Vol 11 (6) ◽

pp. e046616

Author(s):

Rokuhiro Asahina ◽

Hiroyuki Tsuda ◽

Yuki Nishiko ◽

Kazuya Fuma ◽

Momoko Kuribayashi ◽

...

Keyword(s):

Cohort Study ◽

Vaginal Delivery ◽

Umbilical Cord ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Caesarean Delivery ◽

Cord Prolapse ◽

Umbilical Cord Insertion ◽

Umbilical Cord Prolapse ◽

Second Twin

ObjectiveThis study aimed to evaluate the success rate of vaginal delivery, the reasons for unplanned caesarean delivery, the rate of umbilical cord prolapse and the risk of umbilical cord prolapse in twin deliveries.DesignRetrospective cohort study.SettingSingle institution.ParticipantsThis study included 455 women pregnant with twins (307 dichorionic and 148 monochorionic) who attempted vaginal delivery from January 2009 to August 2018. The following criteria were considered for vaginal delivery: diamniotic twins, cephalic presentation of the first twin, no history of uterine scar, no other indications for caesarean delivery, no major structural abnormality in either twin and no fetal aneuploidy.ResultsThe rate of vaginal delivery of both twins was 89.5% (407 of 455), caesarean delivery of both twins was 7.7% (35 of 455) and caesarean delivery of only the second twin was 2.9% (13 of 455). The major reasons for unplanned caesarean delivery were arrest of labour and non-reassuring fetal heart rate pattern. The rate of umbilical cord prolapse in the second twin was 1.8% (8 of 455). Multivariate analysis revealed that abnormal umbilical cord insertion in the second twin (velamentous or marginal) was the only significant factor for umbilical cord prolapse in the second twin (OR, 5.05, 95% CI 1.139 to 22.472, p=0.033).ConclusionsAbnormal umbilical cord insertion in the second twin (velamentous or marginal) was a significant factor for umbilical cord prolapse during delivery. Antenatal assessment of the second twin’s umbilical cord insertion using ultrasonography would be beneficial.

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