Perinatal Mortality and Umbilical Cord Parameters: Is there Any Association?

Abstract

Introduction: Abnormal cord parameters associate with high rate of asphyxia during delivery, foetal anomalies, non-reassuring foetal status, respiratory distress, foetal growth restriction and delivery interventions.Objective: To study the correlation between umbilical cord parameters and perinatal mortality. Materials and methods:This was a prospective study carried out in the Umaid Hospital, Dr. S N Medical College, Jodhpur from March-2014 to November-2014. It included 500 cases admitted to labour room with period of gestation >37 weeks. Details of delivery of baby including mode of delivery, Apgar score, NICU admission and any congenital anomaly found in unbooked cases post-natally was noted down. Umbilical cord parameters were also noted and correlated with perinatal outcome using Fischer's exact test and Chi square test. Results:Out of 500 cases, the cord length was normal in 88.2% cases while it was short in 6.2% and long in 5.6% cases. True knots were associated with a higher mean cord length of 95.83 ± 24.99 cm. The difference of mean cord length between single loop and more than two loops was highly significant (p value<0.001). Cesarean section rate was found to be significantly different between one loop and more than two loops (p<0.001). Conclusion:The excessively long cords are associated with cord prolapse, true knot and poor fetal outcome and increased operative interference. Short cords are associated with failed progress, cord rupture and congenital malformations. Nuchal cords are responsible for threatening fetal well being along with other placental as well as intrapartum factors for poor fetal outcome parameters of umbilical cord were examined at the time of delivery and after delivery: presence of any loop around neck, trunk, shoulder, etc. cord loops tight or loose in LSCS cases, number of loops of cord and positions, knots of cord (true or false), length and diameter of umbilical cord. Amongst these, we have excluded hypo and hypercoiled cords as there is much fluctuation in the number of coils with passage of time, postnatally. Determination of length of umbilical cord was done after the delivery of fetus, cord was clamped at two places and cut in between. From the cut end up to fetal umbilicus and placental attachment umbilical cord, length was measured with flexible tape in cm and added. A data check sheet was maintained for each case till completion of delivery. The umbilical cord length measurements were categorized into short, when the measured length was <39 cm, normal, when the measurement was between 39 to 95 cm and long cord if the measurement was >95 cm [1,2]. Statistical analysis was performed using SPSS17.0 for windows. The sample size of the study was calculated as 400 taking the power as 90% and 20% dropout. Continuous data were analyzed by t-test and categorical data by using Chi-square test or Fisher exact test. J Preg Child Health, an open access journal

Perinatal outcome in Umbilical Cord Entanglement

“…The findings of the current study corroborate those of Soliriya et al (6) , who discovered that 11 (9.24%) out of 119 cases with nuchal cord showed changes in the foetal heart rate. 19 (15.96%) patients were brought to the NICU, of which 17 (14.28%) had low Apgar scores, one infant was macrosomic, and the other had a congenital defect.…”

“…According to the study, instances with nuchal cords have considerably longer mean chord lengths than cases without nuchal cords, which is consistent with Soliriya et al (6) .…”

“…In the study group, there was significant increase in the total foetal complications in cases with multiple number of loops compared to those with single loop with p value 0.000. Low Apgar score, NICU admission and Perinatal fetal death were clinically significant between single and multiple loops, and the p value were 0.007, 0.011, 0.043 respectively as shown in table (6). There was significant increase in the length of the cord in the study group compared to control group with p value 0.000 as shown in table (9).…”

“…Cord anomalies are linked to a number of issues, including foetal hypoxia during birth, growth retardation, respiratory issues, and labour difficulties. Because of their impact on umbilical blood flow, nuchal cords are one of the factors that put a foetus at danger of dying (6) .…”

Placental and Umbilical Cord Indices and Their Association with Fetal Distress in Hadiya Zone Public Hospitals, Southern Ethiopia: A Cross-Sectional Study

“…These findings are supported by previous findings. 14 , 16 , 26 It is believed that excessive traction on the short cord during the descent of the fetus results in occlusion of the cord vessels and leads to failed progress and cord rupture. 26 Similarly, long umbilical cords can cause cord prolapse 26 and which might be explained in the term of cord entanglement (true knots or cord loops around the neck or body parts) and cause perinatal complications like, neurological damage and fetal death.…”