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.