Introduction
Umbilical cord prolapse (UCP) is an obstetric emergency that warrants urgent intervention by an efficient multidisciplinary team to avert adverse foetal outcomes. Conventionally, it is defined as presentation of the umbilical cord at the cervical os before the foetal presenting part1. There has been a marked reduction in incidence of UCP over the last three decades because of increased obstetric vigilance and increased employment of Caesarean deliveries for non-cephalic or unengaged presenting part. The overall incidence varies from 1-6 per 1000 hospital births2.
Compression and vasospasm of foetal vessels from exposure to extrauterine environment ultimately leads to foetal demise in the absence of timely intervention and delivery4. Perinatal mortality varies depending on gestational age, presentation characteristics and implementation of timely interventions. Higher rates of 23-27% are reported in low income countries and 6-10 % in high-income nations5,6.
Scrutiny of risk factors for UCP would alert the attending clinician to be prepared for the complication7.
To adequately manage this obstetric emergency, tested protocols should be set in place. Clinical practice guidelines developed by an expert committee, containing comprehensive information including risk factors and established management strategies, are relevant for good clinical practice8. Although adoption of clinical practice guidelines attempts to keep foetal morbidity and mortality to a minimum, such recommendations would be better appraised by auditing local foetal outcomes to reflect on the need for changes in care9.
In countries where there are no existing national guidelines, it is essential to adopt existing guidelines of high standards. Although several clinical protocols on UCP are available, an appraisal of these guidelines have not been done unlike the systematic appraisals of practice guidelines on gestational diabetes mellitus10and postpartum hemorrhage11 utilizing AGREE II.
The Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II), was designed by the AGREE Research Trust funded by the Canadian Institutes of Health Research. Its purpose is threefold, one of which is to assess a guideline before adopting its recommendations12. Another is to provide guideline developers a structure for rigorous development methodology. The Green-Top Guidelines by the RCOG (UK) follows such rigor13.
The aim of this review is to appraise the available guidelines on UCP using AGREE II -2010, based on their recommendations. Hopefully, this quality appraisal would provide an objective evaluation of selected CPGs on management of UCP.