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Nuchal cord is not associated with adverse perinatal outcome


Objective: The present study was aimed at evaluating the outcome of pregnancies with nuchal cord. Methods: A retrospective population-based study of all deliveries during the years 1988–2003 in a tertiary medical center was conducted. Immediate perinatal outcome of patients with and without nuchal cord was compared. Results: Of 166,318 deliveries during the study period, 14.7% had a nuchal cord, documented at birth (n=24,392). Higher rates of labor induction and non-reassuring fetal heart rate patterns were noted among pregnancies with nuchal cord as compared with the control group (30.1% vs. 24.2%; OR=1.3, 95% CI 1.3–1.4, P<0.001 and 4.5% vs. 2.6%; OR=1.8, 95% CI 1.6–1.9, P<0.001; respectively). The cesarean delivery rate was significantly lower among pregnancies with nuchal cord (11.5% vs. 12.7%; OR=0.9, 95% CI 0.8–0.9, P=0.001). Although 1 min Apgar scores lower than 7 were more common in pregnancies with nuchal cord (4.8% vs. 4.4%; OR=1.1, 95% CI 1.01–1.2, P=0.008), these pregnancies actually had lower rates of 5 min Apgar scores less than 7 (0.5% vs. 0.7%; OR=0.8, 95% CI 0.6–0.9, P=0.004). Likewise, the perinatal mortality rate was significantly lower in pregnancies with nuchal cord as compared with the comparison group (11/1,000 vs. 16/1,000; OR=0.7, 95% CI 0.6–0.8, P=0.001). Conclusions: Nuchal cord is not associated with adverse perinatal outcome. Thus, labor induction in such cases is probably unnecessary.

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  1. 1.

    Osak R, Webster KM, Bocking AD, Campbell KM, Richardson BS (1997) Nuchal cord at birth impacts on fetal size relative to that of the placenta. Early Hum Dev 49:193–202

    PubMed  Article  CAS  Google Scholar 

  2. 2.

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

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Dhar KK, Ray SN, Dhall GI (1995) Significance of nuchal cord. J Ind Med Assoc 93:451–453

    CAS  Google Scholar 

  4. 4.

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

    PubMed  CAS  Article  Google Scholar 

  5. 5.

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

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Miser WF (1992) Outcome of infants born with nuchal cords. J Fam Pract 34:441–445

    PubMed  CAS  Google Scholar 

  7. 7.

    Williams MC, O’Brien WF (2000) Nuchal cords and cord knots predispose to altered fetal growth. Am J Obstet Gynecol 182:S73

    Google Scholar 

  8. 8.

    Kumari S, Saxena A, Monga D (1992) Significance of cord problems at birth. Indian Pediatr 29:301–305

    PubMed  CAS  Google Scholar 

  9. 9.

    Sheiner E, Hallak M, Shoham-Vardi I, Goldstein D, Mazor M, Katz M (2000) Determining risk factors for intrapartum fetal death. J Reprod Med 45:419–424

    PubMed  CAS  Google Scholar 

  10. 10.

    Oron T, Sheiner E, Shoham-Vardi I, Mazor M, Katz M, Hallak M (2001) Risk factors for antepartum fetal death. J Reprod Med 46:825–830

    PubMed  CAS  Google Scholar 

  11. 11.

    Collins JH (1999) Tight nuchal cord morbidity and mortality. Am J Obstet Gynecol 180:251

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Collins JH (2002) Umbilical cord accidents: human studies. Semin Perinatol 26:79–82

    PubMed  Article  Google Scholar 

  13. 13.

    Mastrobattista JM, Hollier LM, Yeomans ER, Ramin SM, Day MC, Sosa A, Gilstrap LC (2005) Effects of nuchal cord on birthweight and immediate neonatal outcomes. Am J Perinatol 22:83–85

    PubMed  Article  Google Scholar 

  14. 14.

    Gonzalez-Quintero VH, Tolaymat L, Muller AC, Izquierdo L, O’Sullivan MJ, Martin D (2004) Outcomes of pregnancies with sonographically detected nuchal cords remote from delivery. J Ultrasound Med 23:43–47

    PubMed  Google Scholar 

  15. 15.

    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

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    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

    PubMed  Article  Google Scholar 

  17. 17.

    Carey JC, Rayburn WF (2003) Nuchal cord encirclements and birth weight. J Reprod Med 48:460–462

    PubMed  Google Scholar 

  18. 18.

    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

    PubMed  Google Scholar 

  19. 19.

    Bohem FH (1975) Prolonged end stage fetal heart rate decelerations. Obstet Gynecol 45:579–582

    Google Scholar 

  20. 20.

    Sheiner E, Hadar A, Hallak M, Katz M, Mazor M, Shoham-Vardi I (2001) Clinical significance of fetal heart rate tracings during the second stage of labor. Obstet Gynecol 97:747–752

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Assimakopoulos E, Zafrakas M, Garmiris P, Goulis DG, Athanasiadis AP, Dragoumis K, Bontis J (2005) Nuchal cord detected by ultrasound at term is associated with mode of delivery and perinatal outcome. Eur J Obstet Gynecol Reprod Biol 123:188–192

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Simhayoff N, Sheiner E, Levy A, Hammel RD, Mazor M, Hallak M (2004) To induce or not to induce labor a macrosomic dilemma. Gynecol Obstet Invest 58:121–125

    PubMed  Article  Google Scholar 

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Correspondence to Eyal Sheiner.

Additional information

Presented in part at the 15th World Congress on Ultrasound in Obstetrics and Gynecology 25–29 September 2005, Vancouver, Canada.

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Sheiner, E., Abramowicz, J.S., Levy, A. et al. Nuchal cord is not associated with adverse perinatal outcome. Arch Gynecol Obstet 274, 81 (2006).

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  • Nuchal cord
  • Perinatal outcome
  • Apgar scores
  • Perinatal mortality