Cevat Rifat CÜNDÜBEY, Mehmet AK, Mustafa Bertan DEMİR, Şeyma DAĞLITUNCEZDİ ÇAM

Exploring the impacts of a nuchal cord on perinatal outcomes in vaginal delivery

Objectives: To investigate the frequency of cord entanglement and neonatal outcomes in vaginal deliveries. Methods: A total of 24,623 patients who had vaginal delivery at at Kayseri City Hospital between July 2018 and January 2023 were included in the study. The incidence of nuchal cord was determined in the study group. The characteristics and perinatal outcomes of groups with and without nuchal cord were compared. Chi-square test was used for statistical evaluation. A p value less than 0.05 was considered significant in the evaluation. Results: The rate of cord entanglement in the neck at birth was 15.7%. There was no statistically significant difference between the infant weights, genders, maternal ages, hospitalization rates in the neonatal intensive care unit, and apgar scores at the 1st and 5th minutes of the babies included in the study. We detected amniotic fluid with meconium in 506 (13.1%) patients with a nuchal cord and 270 (1.3%) without a nuchal cord, and the difference was found to be significant. Conclusions: There is no significant relationship between vaginal deliveries with the nuchal cord and poor perinatal outcomes, except for meconium amniotic fluid. For this reason, pregnant women diagnosed with nuchal cord in the third trimester can deliver vaginally, but they should be carefully monitored in terms of meconium and related complications. However, neonates with nuchal cord do not have significantly longer neonatal hospital stays, and thus the adverse effects of nuchal cord may be transient.

Keywords:

Nuchal cord, vaginal delivery, meconium, perinatal outcomes,

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1. Peesay M. Nuchal cord and its implications. Matern Health Neonatol Perinatol 2017;3:28.
2. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 25th ed., McGraw-Hill Education, 2018.
3. Clapp JF, Stepanchak W, Hashimoto K, Ehrenberg H, Lopez B. The natural history of antenatal nuchal cords. Am J Obstet Gynecol 2003;189:488-93.
4. Collins JH, Collins CL, Weckwerth SR, De Angelis L. Nuchal cords: timing of prenatal diagnosis and duration. Am J Obstet Gynecol 1995;173 (3 Pt 1):768.
5. Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R. Nuchal cord is not associated with adverse perinatal outcome. Arch Gynecol Obstet 2006;274:81-3.
6. Shrestha NS, Singh N. Nuchal cord and perinatal outcome. Kathmandu Univ Med J 2007;5:360-3.
7. Lal N, Deka D, Mittal S. Does the nuchal cord persist? An ultrasound and color Doppler based prospective study. J Obstet Gynaecol Res 2008;34:314-7.
8. Schaffer L, Burkhardt T, Zimmermann R, Kurmanavicius J. Nuchal Cords in term and Postterm Deliveries- do we need to know? Obstet Gynecol 2005;106:23-8.
9. Spellacy WN, Gravem H, Fisch RO. The umbilical cord complications of true knots, nuchal coils, and cords around the body. Report from the collaborative study of cerebral palsy. Am J Obstet Gynecol 1966;94:1136-42.
10. Hankins GD, Snyder RR, Hauth JC, Gilstrap LC 3rd, Hammond T. Nuchal cords and neonatal outcome. Obstet Gynecol 1987;70: 687-91.
11. Singh G, Sidhu K. Nuchal cord: a retrospective analysis. Med J Armed Forces India 2008;64:237-40.
12. Gonzalez-Quintero VH, Tolaymat L, Muller AC, Izquierdo L, O’Sullivan MJ, Martin D. Outcomes of pregnancies with sonographically detected nuchal cords remote from delivery. J UltrasoundMed 2004;23:43-7.
13. Peregrine E, O’Brien P, Jauniaux E. Ultrasound detection of nuchal cord prior to labor induction and the risk of Cesarean section. Ultrasound Obstet Gynecol 2005;25:160-4.
14. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care. 6th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2007.
15. Çetin H, Altın H. [Meconium aspiration syndrome]. S.D.Ü. Tıp Fak. Derg 2006;13:42-6. [Article in Turkish]
16. Ward M, Sinn J. Steroid therapy for meconium aspiration syndrome in newborn infants. CochrancDatabasc Syst Rev 2003;2003(4):CD003485.
17. Halliday HL, Speer CP, Robertson B. Treatment of severe meconium aspiarion syndrome with porcine surfactant. Eur J Pediatr 1996;155:1047-51.
18. Ogawa Y, Shimizu H. Current strategy for management of meconium aspiration syndrome. Acta Paediatr Taiwan 2000;41:241-5.
19. Costa DE, Nair AK, Pai MG, Khusaiby SM. Steroid in full term infants with respiratory failure and pulmonary hypertension due to meconium aspiration syndrome. Eur J Pediatr 2001;160:150-3.
20. Salvia-Roiges MD, Carbonell-Estrany X, Figueras-Aloy J, Rodrigues-Miguelez JM. Efficacy of three treatment schedules in severe meconium aspiration syndrome. Acta Paediatr 2004;93:60-5.
21. Pulmonary Diseases. In: Gomella TL, Cunningham MD, Eyal FG, Zenk KE, eds., Neonatology, 4. ed, Appleton&Lange, 1999; pp. 506-10.
22. Masad R, Gutvirtz G, Wainstock T, Sheiner E. The effect of nuchal cord on perinatal mortality and long-term offspring morbidity. J Perinatol 2020;40:439-44.
23. Carey JC, Rayburn WF. Nuchal cord encirclements and risk of stillbirth. Int J Gynaecol Obstet 2000;69:173-4.
24. Henry E, Andres R, Christensen RD. Neonatal outcomes following a tight nuchal cord. J Perinatol 2013;33:231-4.
25. Kong CW, Chan LW, To WW. 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 2015; 292:283-9.
26. Ogueh O, Al-Tarkait A, Vallerand D, Rouah F, Morin L, Benjamin A, Usher RH. Obstetrical factors related to nuchal cord. Acta Obstet Gynecol Scand 2006;85:810-4.
27. Ghosh GS, Gudmundsson S. Nuchal cord in post-term pregnancy relationship to suspected intrapartum fetal distress indicating operative intervention. J Perinat Med 2008;36:142-4.
28. Miser WF. Weight outcome of infants born with nuchal cords. J Fam Pract 1992;34:441-5.
29. Uludağ S, Azli TM, Şen C, Ocak V. Boyunda kordon dolanmasının doğum eylemi üzerine etkisi. Perinatoloji Dergisi 1994;2:251-4.
30. Larson JD, Rayburn WF, Crosby S, Thurnau GR. Multiple nuchal cord entanglements and intrapartum complications. Am J Obstet Gynecol 1995;173:1228-31.
31. Jauniaux E, Ramsay B, Peellaerts C, Scholler Y. Perinatal features of pregnancies complicated by nuchal cord. Am J Perinatol 1995;12:255-8.
32. Rhoades DA, Latza U, Mueller BA. Risk factors and outcomes associated with nuchal cord. A population-based study. J Reprod Med 1999;44:39-45.
33. Kan-Pun-Shui, Eastman NJ. Coiling of the umbilical cord around the foetal neck. J Obstet Gynaecol Br Emp 1957;64: 227-8.
34. Dippel L. Maligned umbilical cord entanglements. Am J Obstet Gynecol 1964;88:1012-7.