Abstract
Prolapse of the umbilical cord (PUC) has been considered a cause of stillbirth and neonatal hypovolemic shock. Traditional theory held that, during labor, a significant portion of blood volume leaves the fetus between contractions, while placental blood does not reach the fetus because of cord compression. This theory antedated modern management of PUC. The objectives of this study were to determine the impact of current management of PUC with tocolysis, maternal position changes, cord reposition and prompt C-section, on fetal/neonatal mortality and on incidence of neonatal hypovolemic shock. 38,585 deliveries occuring during 2½ yrs. were reviewed, and there were 103 (0.37%) cases of PUC identified. Hypovolemia was evaluated by clinical signs of hypoperfusion, heart rate, blood pressure and Hct changes during the first 5 hours of life. Stillbirth rate in PUC was 8 times that without PUC. Infants born after PUC did not have low Apgar scores. There were no neonates with clinical evidence of hypovolemia or shock. Heart rate, blood pressure, and Hct from those born with PUC were not significantly different from normal. This study shows: a)high incidence of stillbirths associated with PUC, b)virtual absence of cardiovascular and clinical signs of hypovolemia in neonates born after PUC. We conclude that with current perinatal management, PUC is not a cause of neonatal hypovolemic shock; however, further early diagnostic efforts are required if the high incidence of stillbirths associated with PUC is to be reduced.
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Cabal, L., Morales, I., Patkos, P. et al. 518 IS PROLAPSE OF UMBILICAL CORD A CAUSE OF NEONATAL HYPOVOLEMIC SHOCK?. Pediatr Res 19, 197 (1985). https://doi.org/10.1203/00006450-198504000-00548
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DOI: https://doi.org/10.1203/00006450-198504000-00548