Results
The study flow diagram was demonstrated in Figure 2. Among 1017 cases of
CP from the JOCSC database, 131 were considered to be associated with
umbilical cord troubles in singleton pregnancies. Five cases were
excluded because of uninterpretable or missing FHR data, and 126 cases
were analyzed.
The characteristics of our study cohort were shown in Table 1. 24.6%
were complicated with preterm premature rupture of membranes, the
trans-cervical balloon catheter was used for cervical ripening in
17.5%, and most cases were delivered by the emergency cesarean section
(63.5%). More than half in the umbilical cord arterial pH was no less
than 7.0 (57.8%). However, the Apgar scores were lower than normal in
most CP cases (Apgar score <7: at 1 min, 96.8%; at 5 min,
83.9%, respectively)
The FHR classifications and those
stratified by the umbilical cord troubles are shown in Figures 3 and 4.
Overall, nearly half of CP caused by umbilical cord troubles occurred
with a sudden evolution pattern during delivery (R-PD, 43%). On the
contrary, approximately one-third of those showed abnormal FHR patterns
on admission (P-Brady and P-NR, 33%). The FHR class analysis divided by
umbilical cord prolapse and the other morphological abnormalities showed
that nearly 90% of CP due to umbilical cord prolapse developed FHR
deterioration during labor, particularly with R-PD. Meanwhile,
approximately 40% of those associated with cord morphological
abnormalities had already shown abnormal FHR patterns on admission,
mostly persistently non-reassuring patterns.
Timing and type of evolution
patterns of abnormal FHR stratified by umbilical cord troubles are
demonstrated in Table 2. In cases of various umbilical cord
abnormalities, such as velamentous insertion, true knots, constriction,
and hyper-coiled cords, around half of the patients already had FHR
alterations at the time of admission. In terms of the intrapartum onset,
most FHR deteriorations occurred during the first stage of labor in all
types of cord troubles. Furthermore, most patients complicated with
velamentous insertion and multiple entanglements developed CP with Hon’s
pattern.