Rapid response team can improve the perinatal outcomes of spontaneous umbilical cord vascular rupture during the labour– a retrospective cohort study of a tertiary hospital

Abstract

Background Spontaneous umbilical cord vascular rupture(UCVR)is a rare but catastrophic event, and may lead to fetal blood loss and severe perinatal morbidity and mortality. UCVR remains difficult to diagnose, so when it happen, the effective treatment is a key to improve the pregnancy outcomes.UCVR as an obstetric emergency situation especially for neonate, whether rapid response team(RRT) could have effectiveness on the pregnancy outcomes is rare reported. Methods A retrospective cohort study of twelve patients with spontaneous UCVR from 2012 to 2022 were undertaken. Data and images of UCVR were collected via the electronic case system.Demographic and clinical characteristics were collected by researchers. Results Twelve patients were diagnosed by postpartum placental examination and pathological examination. The mean age of participants was (29.67 ± 3.75) years, the mean BMI was (20.48 ± 2.43)kg/m2, the mean gestational age at which rupture occurred was (37.33 ± 2.61)weeks. The decision to delivery interval(DDI) was from 5 to 15 minutes.2 of them were marginal umbilical cord insertion, 5 were velamentous insertion. 9 cases were bloody amniotic fluid. Although all the umbilical cord lengths were within the normal range (38–70 cm), 5 had the umbilical cord around their necks. 10 were vein rupture, 1 was artery and 1 was both atery and vein rupture. About the pregnancy complications, mainly complicated with fetal distress,premature rupture of the membranes(PROM) ,anemia, velamentous cord insertion(VCI), GDM and racket placenta. 6 of them with abnormal placental insertion. all the neonates were admitted to the neonatal intensive care unit (NICU)for 1 to 63 days. Except for one case of stillbirth during the vaginal labour, there were 11 livebirths who underwent cesarean section. One died two days after birth due to severe complications.They were mainly complicated with hypoxic ischemic encephalopathy(HIE),severe neonatal asphyxia and neonatal pneumonia. But with a well prognosis after more than 1 year’s follow-up. Conclusions Early identification of spontaneous UCVR by FHR and character of amniotic fluid during labour is important. Once vascular rupture occurs, obstetric RRT should be activated and the emergency CS should be performed with shorter DDI to reduce perinatal mortality.