Risk factors of clinical birth asphyxia and subsequent newborn death following nuchal cord in a low-resource setting

Abstract

Introduction: Our aim was to identify the risk factors of clinical birth asphyxia and subsequent newborn death in the presence of nuchal cord in a sub-Saharan Africa setting. Methodology: It was a six-months' case-control study involving 117 parturients whose babies presented with a nuchal cord at delivery. The study was carried out at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon, from January 1 st to June 30 th 2013. Results: The risk factors of clinical birth asphyxia identified were: first delivery, absence of obstetrical ultrasound during pregnancy, nuchal cord with more than one loop, duration of second stage of labor more than 30 minutes during vaginal delivery. The risk factors for newborn death from clinical birth asphyxia in the presence of nuchal cord were: maternal age < 20 years, first delivery, absence of obstetrical ultrasound during pregnancy, nuchal cord with more than one loop, tight nuchal cord, duration of second stage of labor more than 30 minutes during vaginal delivery. Conclusion: We recommend a systematic obstetrical ultrasound before labor, so as to detect the presence of a nuchal cord, its tightness and the number of loops. Also, cesarean section should be considered when a nuchal cord is associated with first delivery, tightness or multiple looping.

<p>Risk Factors of Birth Asphyxia Among Neonates Born in Public Hospitals of Tigray, Northern Ethiopia</p>

“…This result was consistent with the study done in different parts of the world. 16,23,24 This is due to the fact that umbilical cord is responsible for providing the fetus with oxygen-rich, nutrient-rich blood and for carrying deoxygenated, nutrient-depleted blood back to the placenta. If the nuchal cord interferes with these processes by compressing the umbilical cord, or blocks the arteries and veins in the fetal neck this can cause a loss of fetal oxygen.…”

Predictive factors for perinatal death in nuchal cord cases: a case control study

“…3,17 This factor has already been reported as a predisposition to birth asphyxia and neonatal death. 6 In this study, tight nuchal cord was a very significant predictive factor for perinatal death. It is the most common factor associated with adverse neonatal outcomes in nuchal cord cases.…”

“…It is the most common factor associated with adverse neonatal outcomes in nuchal cord cases. 1,6,8,17 However, study results must be considered with some limitations. The number of subjects included in the case group was limited, just equal to the calculated minimal sample size.…”

“…[1][2][3][4][5][6] In Cameroon, the reported incidence of nuchal cord at delivery varies according to different authors from 5.5% to 16.2%. [6][7][8] Maternal age <20 years, first delivery, absence of obstetrical ultrasound during pregnancy; nuchal cord with more than one loop, tight nuchal cord, duration of second stage of labor more than 30 minutes during vaginal delivery have been identified in a previous study as risk factors of birth asphyxia and subsequent newborn death. 6 However, the perinatal period as a whole was not considered, and a multivariate analysis was not done to identify independent risk factors.…”

“…[6][7][8] Maternal age <20 years, first delivery, absence of obstetrical ultrasound during pregnancy; nuchal cord with more than one loop, tight nuchal cord, duration of second stage of labor more than 30 minutes during vaginal delivery have been identified in a previous study as risk factors of birth asphyxia and subsequent newborn death. 6 However, the perinatal period as a whole was not considered, and a multivariate analysis was not done to identify independent risk factors. The objective of this study was therefore to identify the independent predictive factors for perinatal death in nuchal cord cases.…”