Nuchal Encirclement by the Umbilical Cord

Abstract

Nuchal encirclement by the umbilical cord is a common cause of fetal distress, and may result in neonatal depression and acidaemia. Severe irregularity of the fetal heart gives prolonged warning of the condition. The temporal relationship of transient episodes of bradycardia to uterine contractions is not helpful in differentiating cord entanglement from other causes of fetal hypoxaemia. Tipton, R. H. (1971): M.D. Thesis, Sheffield University. Tipton, R. H., and Shelley, T. (1971): Journal of Obstetrics and Gynaecology of the British Commonwealth. 78,702.

Lipid peroxidation in cord blood: the effects of umbilical nuchal cord

“…In this study we were unable to demonstrate significant elevation of MDA or OHP levels in the cord blood of infants with loose‐nuchal cord: rather a significant decrease was observed. This could explain the differences observed in previous studies 5,8,19 where the severity of nuchal cord tightness was not stated. This group was also noted to have a significantly higher mean AFI than either the tight‐ or non nuchal cord groups.…”

“…A nuchal cord is associated with altered oxygen saturation in umbilical arterial blood and with increased frequency of fetal distress in labour 6,7 . A direct relation has been demonstrated between fetal acid‐base balance and the subsequent neonatal course 8 . However, there are no publications concerning possible association between oxygen‐free radical activity and nuchal cord entanglement.…”

Early decelerations of the fetal heart rate from occlusion of the umbilical cord

“…Similar findings have been reported by other centers [3,18,21]. In an attempttoreduce this number of antepartum fetal deaths we decided to monitor the fetal heart rate in patients admitted prior to labor (during the first 24 hours after admission).…”

Ultrasound detection of nuchal cord prior to labor induction and the risk of Cesarean section

“…The presence of a nuchal cord has been associated with many different factors in the mother, fetus, cord, placenta and labor and with a less favorable fetal outcome; however, the majority of these studies are case reports or small series. There are reports of associations with breech presentation, right‐sided fetal position, a male fetus, increased fetal activity, reduced fetal movements30, a long length and less vascular coiling of the cord31, 32, abnormal umbilical artery Doppler findings33, abnormal ductus venosus velocity waveforms34, a posterior placenta35, induction of labor4, variable decelerations of the fetal heart rate4, 14, 36, 37, meconium‐stained amniotic fluid4, 14, 37, 38, shoulder dystocia39, operative vaginal delivery14, emergency lower segment Cesarean section38, IUGR7, 8, low Apgar scores4, 14, 17, 40, increased neonatal unit admission38, need for resuscitation4, umbilical artery acidemia14, 41, neonatal hypovolemic shock42, neonatal anemia10, dural sinus dilatation43, stillbirth17, 44, 45, poor neurodevelopmental performance at 1 year3 and cerebral palsy46, 47. Despite these reports, a nuchal cord is usually associated with a normal neonatal and maternal outcome.…”

“…The present study found that women with a nuchal cord did not have a significantly higher risk of emergency Cesarean section or of Cesarean section for fetal distress. Nuchal cord has been consistently associated with an increased rate of fetal heart rate abnormalities, so there has been concern that this might lead to a higher chance of Cesarean section for presumed fetal distress4, 14, 36, 37. We found no such association in the present study, but our sample size was relatively small compared to other studies that have found such an association38.…”