Prolapse of the cord: reduction of perinatal mortality by bladder instillation and cesarean section.

The fetal outcome in 135 cases of cord prolapse seen during the period 1970-79 was studied. The fetus was alive at diagnosis in 127 cases. In 88 (69.3%) of the cases, the cord prolapsed during the first stage of labor and they were managed by Vago's method of rapid instillation of saline into the bladder to relieve cord pressure during preparation for cesarean section (CS). In the remaining 39 cases, the cord prolapsed during the second stage of labor and the patients were delivered vaginally. The overall perinatal mortality rate was 8.1%. The perinatal mortality rate among cases with a live fetus at diagnosis was 2.4%. In spite of a long diagnosis-delivery interval, no fetal deaths occurred in the 88 cases managed by bladder instillation and CS. Vaginal delivery of footling presentations was associated with a fetal mortality of 18.2%. The infant depression rate was significantly higher in breech vaginal deliveries than in CSs (P less than 0.001). Fetal bradycardia at the time of diagnosis was associated with an increased infant depression rate following vaginal delivery (39%) as compared with CS (10%). The CS rate in this series is the highest and the perinatal mortality among the lowest yet reported.