NURSING JOURNAL

Student’s Name: __Gido, Claire Alyssa M._____________ Date:_January 4, 2022___

Year/Block/Group:__UP-FC1-2BSN-21____________ Area of Assignment:__________________

Clinical Instructor:__Ma’am Ñina Marie Quintan____________

Fetal demise and associated factors following umbilical cord prolapse in Mulago hospital,
Uganda: a retrospective study

By: Esau Wangi Wasswa, Sarah Nakubulwa & Twaha Mutyaba

Summary of Journal Reviewed

Umbilical cord prolapse is an uncommon obstetric issue that generally requires an

emergency delivery and is linked to a high rate of neonatal morbidity and death. The prolapse
of the umbilical cord might be overt or occult. The cord descends into the vagina or all the way
up to the vulva in the overt kind. When the cord lies beside the presenting portion and can only
be palpated by inserting the finger into the cervical canal, it is referred to as occult umbilical
cord prolapse. According the studies that done in United States, Thailand, and Israel reported
the perinatal mortality of the umbilical cord prolapse between 3-15%. However, there have
been remarkable improvements in neonatal care and the liberal use of cesarean section on
diagnosis, increases to 37.5% in the early 1900s. Before the delivery, various intervention are
used to try to improve fetal outcomes. These include putting mother in knee-chest position,
instillation of fluid into the bladder, giving tocolytics to mothers in labor with UCP and
intrauterine resuscitation.

Interventions such as knee chest position, cervical dilation at the time of UCP diagnosis,
diagnosis to delivery interval, and mode of delivery were among the obstetric factors. An
extraction form was used to enter the data. According to retrospective study that conducted in
Mulago hospital, Uganda, file records of mothers who delivered between 1st January 2000 to
31st December 2009 and had pregnancies complicated by umbilical cord prolapse with live
fetus. Some intervention strategies employed by the develop countries are not performed in
Mulago because of low resource setting. In 438 cases of prolapsed cord, 101 lost their babies
within 24 hours after birth or were delivered dead. So that, there are major factors associated
with fetal outcome in complicated by the UCP that are included the diagnosis to delivery
interval, mode of delivery, and knee-chest position.
 The overall percent of fetal demise is 23% and annual cumulative incidence of fetal
death in pregnancies complications by umbilical cord prolapse in New Mulago is very high for
the 10 years period. Therefore, putting mothers in knee-chest position was found to be
protective against fetal death. The goal of the maneuver is to relieve pressure on the prolapsed
cord, which might lead to partial or full blockage. A study found a similar link between
maternal and fetal mortality of 1.5 percent. The greater death rate of women with DDI may be
related to a higher percentage of women having DDI greater than 30 minutes. If the time
between diagnosis and birth is lengthy, the mother will be in an uncomfortable position. The
mother will most likely shift positions during labour.This might be related to the high volume of
births at Mulago Hospital, which now averages 20 every 24 hours. Longer DDI is caused by
inadequate theatre amenities and understaffing. At the end, there is urgent need to invest in
theatre facilities and manpower to achieve this.