title: Incidence of nuchal cord, mode of delivery and perinatal outcome: a notable experience in Dhulikhel Hospital - Kathmandu University Hospital.
abstract: With the advent of ultrasound as a means of providing quality antenatal care, there is an increase in the diagnosis of nuchal cord in fetuses. The major cause of foetal or neonatal death during labor and in postpartum period is birth asphyxia and tight nuchal cord is a cause of birth asphyxia. Whilst there are instances in which fetuses with 3 to 4 loops of cord around the neck have been delivered by normal vaginal delivery, some cases have to be delivered by caesarean section due to foetal distress caused by a single loop of cord around the neck. The reason for conducting this study was also to analyze the incidence and other aspects of nuchal cord. Dhulikhel Hospital labour registry was reviewed between Jan 2010 and Dec 2011. A total of 289 cases with at least one loop of nuchal cord were recorded as study case. For comparison, 965 controls were randomly selected from the 4219 unaffected singleton births delivered during the same time period. Of 1254 neonates, nuchal cord was present at 6.85% of deliveries (n = 289). Of these the incidence was 6.57% at preterm, 49.13% at term, 39.79% at postdated and 4.50% at postterm. A total of 151 had one loop and 138 had two or more loops. There was significant difference in the maternal age and birth weight of among three groups (control, with one loop and with two or more loops) in this study (p = 0.002) and (p = 0.000) respectively. However, the incidence was not affected by caste, parity, gestational age, antenatal site, neonatal intensive care unit admission and other perinatal complications. Most were primigravida (62.98%) and about 85.12% were delivered vaginally but caesarean section had to be done in 30 cases. And 2.8% cases required neonatal intensive care unit admission for prematurity. Obstetrician working in the periphery should refer the clients to a tertiary care center to confirm a suspicion of nuchal cord (non-engaged foetal head, decreased foetal movements, meconium stained liquor, foetal distress or malpresentation etc.) and also as a routine basis for ultrasound. Clients with confirmed complication should be managed in tertiary hospitals or institutions with the facility of ultrasound, cardiotocography and emergency surgery. This would improve the health of both the mother and fetus.
authors.affiliation: Department of Obstetrics and Gynaecology, Dhulikhel Hospital - Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. drsuman537@yahoo.com
authors.forename: S R
authors.initials: SR
authors.lastname: Tamrakar
mesh_terms: D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D009390:Nepal / Q000453:epidemiology; D053589:Nuchal Cord / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D055815:Young Adult