Neonatal outcome and mode of delivery in the presence of nuchal cord loops: implications on patient counselling and the mode of delivery

Abstract

Only nuchal cord for 3 turns or more was associated with higher incidence of suspected foetal distress. However, the Apgar scores were not affected. Therefore, nuchal cord of any turns was not associated with adverse foetal outcomes. Prenatal ultrasound scan for nuchal cord is, therefore, unnecessary and there should be no differences in management of nuchal cord of any turns.

Rischio cordonale: outcome perinatale e materno

“…Nuchal cord is the most common condition with an incidence of 8.2% on the population studied. These figures, in line with the results obtained by some Authors (incidence of 8% and 9.2%) (6), are lower than many figures in the literature reporting a frequency from 15% to 33% (7). On the other hand they are higher than Kumera's and Dhor's figures report an incidence of 2.4% and 5.74%.…”

Risk factors for nuchal cord entanglement at delivery

“…A nuchal cord is associated with an increased risk of adverse perinatal outcomes. During labor, the incidence of fetal heart rate abnormalities is increased, which may lead to vaginal instrumental delivery or cesarean delivery, especially if there are multiple cord loops, even though some authors did not observe such outcomes . Moreover, the rates of a poor Apgar score and perinatal death are increased in the presence of a nuchal cord, especially if the nuchal cord is tight .…”

Medico-legal issues of the nuchal cord at birth

“…A lot of studies debated over the influence of nuchal cord on perinatal outcomes, and some studies have focused on the effect of multiple, tight nuchal cords and association with other abnormalities such as poor cord coiling, scarce Wharton jelly etc. Many nuchal cords can be predicted easily using antenatal Doppler ultrasonography [14], and have been reported to be associated with decreased conditions that impairs neonatal outcome: low birth weight [15], increased risk of meconium aspiration during labor [16], fetal distress [17], and emergency cesarean delivery [18].…”