Capitulo II. Conceptualización de las variables de la Investigación
2.3. El Burnout y el afrontamiento
LENGTH
Total N (%)No complication
n (%)
*Intrapartum Complications n (%)
Short Cord (Cord length <30cm)
4 3 (75.0%) 1 (25.0%)
Normal 544 515 (94.7%) 29 (5.3%)
Long Cord (cord length >80cm)
40 34 (85.0%) 6 (15.0%)
Total 588 552 (93.9%) 36 (6.1%)
*Total number of cases with intrapartum complications {fetal distress, Cord prolapse, Abruptio, Prolonged second stage, Meconium stained liguor, Shoulder dystocia and Hand prolapse}
Intrapartum complications are more likely to occur when the umbilical cord length is shorter than 30cm and longer than 80cm.
TABLE 8 Mean Umbilical cord length of all deliveries by intrapartum complications.
Intrapartum Complication n Mean umbilical cord (cm)(Std Dev.)
Odd ratio
a) Fetal distress b) Cord prolapse c) Abruptio
d) Prolonged second stage of Labour e) Meconium stained liquor
f) Shoulder dystocia g) Hand prolapse.
h) None
3 5 11 6 8 1 2 552
74.3(+26.57) 86.6(+32.15) 48.8(+11.41) 52.8(+13.34) 63.5(+12.88) 22.0(+0.00) 47.0(+4.00) 57.8(+11.78)
0.14 0.05 0.00 0.36 0.50 0.00 0.00
Kruskal-walli H (equivalent to chi square) P value =0.0114
TABLE 9 Cord length in relation to Cord prolapse Length of cord Number of fetuses
without cord prolapse(%)
Number of fetuses with cord prolapse (%)
Total (%)
< 80cm 546 (99.6%) 2 (0.4%) 548 (93.2%)
>80cm 37 (92.5%) 3 (7.5%) 40 (6.8%)
Total 583 (99.1%) 5 (0.9%) 588 (100.0%)
Odd ratio 0.05(0.01<0R < 0.35), Showing a negative association The higher the cord length the more likelihood for cord prolapse to occur.
Chi Square (An expected cell value is less than 5. fisher exact results recommended, so was used.)Fisher exact = 1 –tailed p-value 0.00265,
TABLE10: Birth Weight In relation to insertion of the umbilical cord
Birth weight (gm)
Umbilical cord insertion
Central Eccentric Marginal
n (%) n (%) n (%) Total (%)
<1500 1 (0.5) 4 (1.3) 0 (0.0) 5(0.9)
>1500-<2500 37 (19.8) 59 (18.6) 9 (10.8) 105(17.9)
>2500 149 (79.7) 255 (80.2) 74 (89.2) 478( 81.3)
Total 187 318 83 588
Figure 2: Means of cord length by Umbilical cord insertion Descriptive Statistics for Each Value of Cross tab Variable
Number Mean Umbilical cord length Mean Birth weight
(cm) (Kg)
Central 187 58.01 (+13.06) 3.0266 (+0.6237) Eccentric 318 58.05 (+12.41) 2.9679 (+0.5585) Marginal 83 56.86 (+12.34) 3.1211 (+0.4503)
ANOVA testing inequality of population means, p-value= 0.7302 and p-0.0789 respectively.P>0.05
TABLE11: Cord Length: Singleton Vs Multiple Cord Length Number of Fetuses
TotalSingleton Multiple
<30cm 4 0 4
30-80cm 519 25 544
>80cm 40 0 40
Total
563 25 588
DISCUSSION
Beall et al in an extensive review of umbilical cord complications cited umbilical cord length to range between 0-300cm with average length of 55cm long9. Our study recorded a mean length of 57.87cm (range 22-124 cm). This is similar to the finding by Purola (1968) who recorded a range of 22-130cm and average length of 59cm24 and that of Rayburn et al (1981) who found mean umbilical cord length to be 55cm and range, 14 to 129cm25 and Moore et al (1995 documented approximately 55cm (range 32-146)26. In this study, there was significant difference between the male and female umbilical cord length (58.16cm +13.3 and 57.59 cm + 11.8kg respectively (p <0.05). This is similar to other studies3,20,21, but contrast the finding by Jaya (1995)27,which reported no difference between the umbilical cords of the male and female fetuses.
Incidence of short cord varies extensively. Four (4) cases measured were less than 30 cm in our study (0.7%) deliveries. This is lower than recorded in most
other studies3. This may have been influence by the cut off of 30 cm used in this study. Rayburn (1981) defined short cord as cord length less 35 cm (lower sixth percentile) and cited to occur in about 6% of pregnancies25. The pressure of short cord has been associated with antepartum abnormalities and as risk factor for complication of labour and delivery. The very short cord length 22 cm recorded in this study was a case of shoulder dystocia a rare occurrence. Past studies have consistently reported selected labour and delivery complications associated with the presence short cords3, including abruptio placentae, prolonged labour25 and fetal distress 29,30. The only intrapartum complication associated with a “short cord” (defined by less than 30cm) in this study was shoulder dystocia. However, Abruptio placentae (mean cord length 48.80cm +11.4), and prolonged second stage of labour (Mean cord length 52.8cm+13.3) were associated with shorter cords (below the mean umbilical cord length for the study population) Cord prolapse, fetal distress, and meconium stained liquor were associate with longer cords.
In a study on 96 consecutive healthy term (37 –40 weeks) infants soon after birth, Bolisetty (2002) found a significant positive correlation between cord weight and length and placental weight and birth weight19. The average placenta weight in our study was 0.58kg (+0.16). There was a positive but insignificant correlation between cord length and placental weight, cord length and birth weight, cord length and gestational age. There was a stronger correlation between placental weight and birth weight. This is in conformity with the findings of Jaya26 and Wu
et al21 in studies of Indian and Taiwanese neonates and those of Younoszai and Haworth among preterm, term and growth retarded infants31. There was no relationship between cord length and parity.
In order to construct a growth chart for umbilical cords Mills (1983) measured the Umbilical cord length in 9620 male and 9068 female infants and related it to the gestational age. In addition to providing a standard for the US white population, the growth charts obtained, illustrated that umbilical cord length is widely divergent at the same gestational age and that umbilical cord growth continues throughout the third trimester32. In my study, the cord length increases as gestational age increases, 51.7cm(+13.0) at 29-34weeks, 57.7cm(+12.4) at 35-40 weeks and 61.17(+13.2) at >35-40 weeks. This contrasts Wu’s (1996) documentation on correlation of cord length with gestational age21, but is in conformity with the finding of Adinma (1993) who reported a significant measure of association between umbilical cord length and gestational age7.
The percentage of female babies at birth was 50.3% while male babies accounted for 49.7%. This is reverse in a study by Jaya (1995) among an Indian population where 49.9% were female babies and 50.1% were male babies27. The preference for male babies with tendency to abort female fetuses in India, may have caused this trend. Males have longer umbilical cords than females (p-less than 0.0001)20,32. This is similar to findings in this study in which the mean umbilical cord length for male infants was 58.16cm (+13.3) as against 57.59cm
(+11.8) for the females. The difference is statistically significant, p<0001. Males also have higher birth weights, placental weights than females. This is similar to other studies 7,20.
Stefos (2003) in a study of 534 Greek parturients found that cord length increased with advancing parity, the cut-off point being between the second and the third deliveries22. In this study, the mean umbilical cord length of primiparae was lower (57.45 cm) than that of multiparae (58.12cm) but the difference was not statistically significant (p>0.05). This observation is similar to Adinma’s findings in a study of 1000 consecutive deliveries where he documented no association between umbilical cord length and parity7. The mean parity in this study was 3 which are similar to that cited by Thieba et al (1998)33 who reported an average of 3 in his study population33.
Nuchal cord (NC) is defined as the umbilical cord being wrapped 360 degrees . One loop around the neck occurs in approximately 20%
around the fetal neck 34
while true knots and multiple loops occur in up to 5% of pregnancies14
of cases13
as been associated with . Nuchal cords h
2.1% of deliveries9
– eported in 0.3 are r
once or more round the neck . Cord can wrap
fetal heart rate abnormalities9,34
leading to strangulation. Dursun reported intrauterine death in a breech nd week of pregnancy, the length of cord was 190cm a presentation at 37Th
. Our study suggest an incidence of loops of 5 times34
round the neck for wrapped
cord and True knots of 7% and 0.3% respectively. This findings is higher than that reported by Egwuate(1985) who reported cord round the neck and true knots This may have been because we lumped
35. ctively to be 2.5% and 0.05% respe
all cases of loops of cord including round the neck, body, leg and hands. Of the fourty –eight cases of cord entanglements/complications, 40 cases (83.3%) occur in umbilical cord length that is within normal range. It is interesting to note that in this study, the mean cord length of all cord abnormalities( True Knot false Knot, 13.2), this is longer than the average but the difference +
stricture) was 63.00cm (
cal cord length with loops of the mean umbili
is not significant p>0.05. However
study of the
) this is higher than the mean umbilical cord length 14.6
+ cord 63.58 (
This is in but here difference is significant p< 0.05.
12.3) + population 57.28(
ficant difference in in which he reported a signi
Adinma finding7
conformity with
the mean cord length of cases of loops of cord and the cord length of
.
uncomplicated deliveries7
. A study on
36 ,
0.62% of deliveries)35
-ncidence of Cord prolapse is cited to be 0.14 The i
umbilical cord prolapse in Burkina Faso recorded on incidence of 7.9 per 1000 deliveries study of 5905 and Egwuatu reported an incidence of 0.47% in a prospective
(0.79%)
. In this study 5 cord prolapses were recorded giving incidence of Nigerian babies35
0.85%. This is slightly higher than cited incidence, this may have been due to the fact that our center has a high incidence of unbooked cases. Three (60%) of the cases of cord prolapse had cord lengths of over 80cm. Odd ratio 0.05 (0.01<or < 0.35), showing a negative associate between cord longer than 80cm and likelihood of cord prolapse.
p-s like Predisposing factor
36. value <0.05(0.00265).This is similar to many other studies
malpresentation, prematurity, twin pregnancy and multiparity were not found to be contributory in our study. The incidence of Shoulder dystocia in this study is 0.17%.
This is lower than findings documented by Henry (2009) 0.5% -1.5%. The cord length in
this case was very short (22cm).The reason for this very short cord is not clear.
It has been cited that umbilical cord normally inserts near the center of the placenta and in approximately 7% of single births the insertion points occur at very edge of the placenta (marginal insertion) and in about 1 % of cases the umbilical cord does not insert into the placenta at all but the fetal vessels ramify through the external membranes before entering the placenta (velamentous insertion)38. This is buttressed by a study on effect of gestational diabetes and maternal Hypertension on gross morphology of placenta by Ashfag (2005), where the insertion of all but one of the placentas studied was centrally located1. In our study the insertion points of 54.1% of the study population were eccentric and 31.8% central. This is similar to the study by Rath (2000) where eccentric ranked highest followed by central and marginal11.Furthermore a study by Perceival (1980) reported that in 73 percent of cases the site of insertion of umbilical cord is eccentric in position39. We recorded no case of velamentaous insertion. Woods and Malan (1978) have studied 940 placentas and found no correlation between the birth weight and the site of cord insertion in normal term infants12. The present study also shows no correlation between umbilical cord insertion and birth weight.This contrast Rath (2000) findings in which he reported
marginal attachment of umbilical cord to be correlated with low birth weight babies11. This may have been as a result of his study population of hypertensives.
Shanklin (1970) had found similar result to Rath’s in a study of 5000 placentae40. The umbilical cord length of the breech presentation although shorter is not significantly different from the vertex presentation. 54.0cm(+10.0) vs 57.87 (+12.6) p> 0.05.This contrast a study on 1000 consecutive deliveries of Igbo women at the Iyi-Inu Mission Hospital in Onitsha, Nigeria by Adinma where the mean cord length for cephalic presentation is (51.7cm) was significant longer than that for breech presentation 46.9cm(p<.05)7.
The two factors that determine umbilical cord length are sufficient space in the amniotic cavity for fetal movement and the tensile force applied to the umbilical cord during fetal movements 41,25. It may mean that factors that impede fetal movement may likely result in shorter umbilical cords and those that permit increased fetal activities may result in longer cords. It is noted that umbilical cord length in twins is generally shorter than for singletons42. The mean cord length among multiple deliveries in this study was 49.25cm (+10.7). This was statistically significant, p<0.05. Adinma reported similar finding (44.3cm vs. 51.5cm; p<0.05)7.The reduced uterine space in multiple gestations may have accounted for this. Polyhydramnious predisposes to longer umbilical cords with
associated sequelae43.
CONCLUSION
We conclude that the umbilical cord length does not significantly correlate with parity of the women. Cord prolapse is more likely to occur in cases with umbilical cord longer than 80 cm. Birth weight was found to correlate with the cord length; placental weight and birth weight and cord length increased with gestational age. No association existed between umbilical cord insertion and birth weight or cord length. The umbilical cord of the male babies was longer than that for the female babies. These findings are consistent with reports from other studies on the subject.
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