Skip to main content
SpringerLink
Log in

Adverse pregnancy outcomes and multiple nuchal cord loops

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the effects of nuchal cord and the number of loops during labor and delivery on delivery outcomes among women with singleton pregnancy who delivered vaginally.

Methods

This retrospective cohort study included 42,798 women with singleton, vertex, and vaginal deliveries at 24–43 weeks of gestation. We analyzed delivery outcomes based on the number of nuchal cord loops.

Results

A total of 42,798 deliveries met the inclusion criteria, of which, 3809 (8.9%) had nuchal cord with 1 loop at delivery, 1035 (2.42%) had 2 loops, and 258 (0.6%) had 3 loops. Nuchal cord with 3 loops compared to no nuchal cord has been associated with higher incidence of intrauterine fetal death (1.9%), Apgar scores less than 7 at 1 and 5 min (7.4%, 2.3%), and higher rate of operative vaginal deliveries (17.5%). Nuchal cord with 2 or 3 loops was associated with higher incidence of intrauterine growth restriction (10.2%, 11.6%).  In a multiple logistic regression model, nuchal cord with 3 loops was an independent risk factor for operative vaginal delivery and Apgar score less than 7 in 1 min.

Conclusions

In the case of vaginal delivery in the presence of nuchal cord, as the number of nuchal cord loops increased, so did the number of adverse delivery outcomes. While 3 loops were associated with higher incidence of intrauterine fetal death, intrauterine growth restriction, increased operative vaginal deliveries, and low Apgar scores, 1 loop was not associated with adverse perinatal outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Clapp JF III, Stepanchak W, Hashimoto K, Ehrenberg H, Lopez B (2003) The natural history of antenatal nuchal cords. Am J Obstet Gynecol 189:488–493

    Article  PubMed  Google Scholar 

  2. Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R (2006) Nuchal cord is not associated with adverse perinatal outcome. Arch Gynecol Obstet 274:81–83

    Article  PubMed  Google Scholar 

  3. Akkaya H, Büke B, Pekcan MK et al (2017) Nuchal cord: is it really the silent risk of pregnancy? J Matern Fetal Neonatal Med 30:1730–1733

    Article  PubMed  Google Scholar 

  4. Sornes T (1995) Umbilical cord encirclements and fetal growth restriction. Obstet Gynecol 86:725–728

    Article  CAS  PubMed  Google Scholar 

  5. Jauniaux E, Ramsay B, Peellaerts C, Scholler Y (1995) Perinatal features of pregnancies complicated by nuchal cord. Am J Perinatol 12:255–258

    Article  CAS  PubMed  Google Scholar 

  6. Abdallah A, Eldorf A, Sallam S et al (2018) Nuchal cord: impact of umbilical artery Doppler indices on intrapartum and neonatal outcomes: a prospective cohort study. J Matern Fetal Neonatal Med. https://doi.org/10.1080/14767058.2018.1463984

    Article  PubMed  Google Scholar 

  7. Narang Y, Vaid NB, Jain S, Suneja A et al (2014) Is nuchal cord justified as a cause of obstetrician anxiety? Arch Gynecol Obstet 289:795–801

    Article  PubMed  Google Scholar 

  8. Zuarez-Easton S, Hosary S, Zafran N et al (2018) Peripartum events associated with severe neurologic morbidity and mortality among acidemic neonates. Arch Gynecol Obstet 297:877–933

    Article  PubMed  Google Scholar 

  9. Walla T, Rothschild MA, Schmolling JC, Banaschak S (2018) Umbilical cord entanglement’s frequency and its impact on the newborn. Int J Legal Med 132:747–752

    Article  PubMed  Google Scholar 

  10. Weiner E, Fainstein N, Schreiber L, Sagiv R, Bar J, Kovo M (2015) The association between umbilical cord abnormalities and the development of non-reassuring fetal heart rate leading to emergent cesarean deliveries. J Perinatol 35:919–923

    Article  CAS  PubMed  Google Scholar 

  11. Vasa R, Dimitrov R, Patel S (2018) Nuchal cord at delivery and perinatal outcomes: single-center retrospective study, with emphasis on fetal acid-base balance. Pediatr Neonatol 59:439–447

    Article  PubMed  Google Scholar 

  12. Yarcı Gursoy A, Ozgu B, Tasci Y, Candar T, Erkaya S, Caglar GS (2018) The impact of nuchal cord on umbilical cord blood gas analysis and ischaemia-modified albumin levels in elective C-section. J Obstet Gynaecol 38:1099–1103

    Article  CAS  PubMed  Google Scholar 

  13. Mastrobattista JM, Hollier LM, Yeomans ER et al (2005) Effects of nuchal cord on birthweight and immediate neonatal outcomes. Am J Perinatol 22:83–85

    Article  PubMed  Google Scholar 

  14. Larson JD, Rayburn WF, Crosby S, Thurnau GR (1995) Multiple nuchal cord entanglements and intrapartum complications. Am J Obstet Gynecol 173:1228–1231

    Article  CAS  PubMed  Google Scholar 

  15. Kong CW, Chan LW, To WW (2015) Neonatal outcome and mode of delivery in the presence of nuchal cord loops: implications on patient counselling and the mode of delivery. Arch Gynecol Obstet 292:283–289. https://doi.org/10.1007/s00404-015-3630-4

    Article  PubMed  Google Scholar 

  16. Schaffer L, Burkhardt T, Zimmermann R, Kurmanavicius J (2005) Nuchal cords in term and postterm deliveries—do we need to know? Obstet Gynecol 106:23–28

    Article  PubMed  Google Scholar 

  17. Qin Y, Wang CC, Lau TK, Rogers MS (2000) Color ultrasonography: a useful technique in the identification of nuchal cord during labor. Ultrasound Obstet Gynecol 15:413–417

    Article  CAS  PubMed  Google Scholar 

  18. Jauniaux E, Mawissa C, Peellaerts C, Rodesch F (1992) Nuchal cord in normal third-trimester pregnancy: a color Doppler imaging study. Ultrasound Obstet Gynecol 2:417–419

    Article  CAS  PubMed  Google Scholar 

  19. Peregrine E, O’Brien P, Jauniaux E (2005) Ultrasound detection of nuchal cord prior to labor induction and the risk of cesarean section. Ultrasound Obstet Gynecol 25:160–164

    Article  CAS  PubMed  Google Scholar 

  20. Dollberg S, Haklai Z, Mimouni FB, Gorfein I, Gordon ES (2005) Birth weight standards in the live-born population in Israel. Isr Med Assoc J 7:311–314

    PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Nava Jelin, MS for data analysis and Faye Schreiber, MS for editing the manuscript. They are employees of Meir Medical Center.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel

    Hanoch Schreiber, Yair Daykan, Nissim Arbib, Ofer Markovitch, Arie Berkovitz & Tal Biron-Shental

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Hanoch Schreiber, Yair Daykan, Nissim Arbib, Ofer Markovitch, Arie Berkovitz & Tal Biron-Shental

Authors
  1. Hanoch Schreiber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yair Daykan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nissim Arbib
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ofer Markovitch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Arie Berkovitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tal Biron-Shental
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HS protocol development, data collection, analysis and interpretation. YD data collection, analysis and interpretation, manuscript writing/editing. NA data analysis and interpretation, manuscript writing/editing. OM data analysis and interpretation, manuscript writing/editing. AB data analysis and interpretation, manuscript writing/editing. TB-S protocol development, data analysis and interpretation. All authors provided final approval of the version to be published.

Corresponding author

Correspondence to Nissim Arbib.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schreiber, H., Daykan, Y., Arbib, N. et al. Adverse pregnancy outcomes and multiple nuchal cord loops. Arch Gynecol Obstet 300, 279–283 (2019). https://doi.org/10.1007/s00404-019-05178-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-019-05178-w

Keywords

Search

Navigation