Abstract: Introduction: Constant observation of fetal heart rate during labour has been used over recent 50 years for antenatal assessment of fetus in view of hypoxemia and acidemia
[1] Abnormality found in fetal heart rate during labour is one of the major indications for immediate delivery or emergent caesarean section worldwide. Such umbilical cord abnormalities include cord entanglements, hypercoiling, true knots, strictures and short cords. Umbilical cord which acts as a lifeline between mother and fetus is an easily accessible and assessable structure and there is some evidence that adverse antenatal and perinatal events could be predicted by examination of umbilical cord abnormalities intraoperatively or postnatally and thus the perinatal outcome can be detected.
Objectives of the study
. To study the correlation between umbilical cord abnormalities and none reassuring fetal heart rate.
. Neonatal outcome in patients with umbilical cord abnormalities.
Methodology: All those women whose Cardiotocography showing non reassuring fetal heart rate according to NICE guidelines, with no maternal or fetal clinical risk factor will be considered for the study. Patients will be followed up till the surgery and intraoperative findings will be noted or will be followed up till vaginal delivery. APGAR scores at 1 minute and 5 minutes seen and cord blood pH (7.36-7.45 as normal) is taken into account to study perinatal outcome. The purpose of the study will be detecting the prevalence and types of umbilical cord variabilities and their correlation with non reassuring heart rate of the fetus and its perinatal outcome. Short cord of less than 30 cms and long cord of more than 70 cms is considered for the study. In our tertiary care hospital in Kolar district of Karnataka, we decided to conduct study with a sample size of 150 patients.
Results: A total of 150 women were taken into the study who belonged within the inclusion criteria. Correlation between CTG and cord abnormalities showed that 73.3% were associated with non reassuring CTG and 26.7% were associated with abnormal CTG. Among the umbilical cord abnormalities noted, 44% were cord entanglements, 25% were long cord and 15% were short cord. In present study, correlation between cord abnormalities and CTG has been established which showed that 30% of long cord showed non reassuring CTG and 80% of cord entanglement showed abnormal CTG. P value being <0.001 was found to be statistically significant on Chi square test. Mean values of pH with long cord is 7.21, short cord is 7.25, knot of the cord is 7.21 and cord entanglement is 7.29 which indicates acidic cord blood pH. P value on anova test is <0.05 which appears to be statistically significant. Hence cord abnormality has been associated with acidic cord blood pH which indicates adverse perinatal outcome.
Conclusion: Umbilical cord abnormalities is being commonly noted during the deliveries but the significance had been ignored. This study shows that there is correlation between incidence of umbilical cord abnormalities and fetal distress identified prior to delivery which is proved statistically significant. Further study establishes correlation between umbilical cord abnormalities and adverse perinatal outcome depicted as cord blood pH acidosis and increased NICU admission.
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