Nuchal cord detected by ultrasound at term is associated with mode of delivery and perinatal outcome.
OBJECTIVE
To evaluate the clinical relevance of nuchal cord in normal, vertex, singleton pregnancies at term, and its effect on mode of delivery and perinatal outcome.


METHODS
Prospective study with 352 normal, singleton pregnancies, with fetuses in the vertex presentation, examined with real-time ultrasound at 37-39 weeks. Health care workers at labour and delivery blinded to previous detection of nuchal cord.


RESULTS
Fetuses of nulliparous women with a nuchal cord were more likely to be delivered with operative vaginal or caesarean delivery (n = 153, p < 0.0001). This was not the case with higher parity (n = 199, p = 0.07). There was no difference between nuchal cord (n = 144) and control groups (n = 208) in amniotic fluid quantity at 37-39 weeks (p = 0.554) or intrapartum CTG (p = 0.9). On the other hand, nuchal cord group had lower Apgar scores at 1 and 5 min (p = 0.001 and 0.027 respectively); this difference remained significant when adjusted for birth weight (p = 0.001 and 0.016), but disappeared when adjusted for mode of delivery (p = 0.048 and 0.319).


CONCLUSIONS
Nuchal cord in normal pregnancies at term is associated with increased rate of operative vaginal and caesarean delivery in nulliparae. The presence of a nuchal cord results in slightly lower Apgar scores at 1 and 5 min, mainly as a consequence of higher operative delivery rates.
Assimakopoulos
E
E
1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, D. Gounari 8, 54621 Thessaloniki, Greece. mpontis@auth.gr
Zafrakas
M
M
Garmiris
P
P
Goulis
D G
DG
Athanasiadis
A P
AP
Dragoumis
K
K
Bontis
J
J
D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007746:Labor Presentation; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D047929:Term Birth; D016216:Ultrasonography, Prenatal; D014470:Umbilical Cord / Q000000981:diagnostic imaging*