Nuchal Cord Entanglements and Gestational Age

Abstract

The purpose of this observational study was to investigate the relation between nuchal cord entanglements and gestational age. Computerized data from our hospital perinatal database were reviewed between January 1990 and December 1994. Data from all deliveries > or = 20 weeks' gestation underwent either a Cochran-Mantel test for trend or Chi-square testing where appropriate. Of the 13,895 singleton deliveries, the finding of an entanglement increased significantly from 5.8% at 20 weeks to 29.0% at 42 weeks' gestation. The frequencies increased linearly, regardless of whether the entanglement involved a single loop (p < 0.001) or multiple loops (p < 0.002). The risk of an antepartum stillbirth was not increased in the presence of a nuchal cord entanglement, even after controlling for other risk factors. These normative data should serve as a reference for prenatal ultrasound examinations and for prospective studies intended to evaluate the predictive value of reporting this finding prenatally.

Perinatal Mortality and Umbilical Cord Parameters: Is there Any Association?

“…Begum et al [5] in their series had no perinatal mortality with nuchal cord which is similar to observation of Larson et al [9] and Miser [10] which does not correspond to our study.…”

Fetal Demise Due to Cord Entanglement in the Early Second Trimester

“…Th ese studies generally support that nuchal cord is a common fi nding in fetal life, with decreasing rates in the newborn (1, 2, 5, 6). However, rather than showing decreasing rates, one study showed that nuchal cord rates increased linearly from 6% in the 20th gestational week to 29% in the 42nd gestational week, regardless of whether the entanglement involved a single loop or multiple loops (3).…”

“…Th e Table lists studies related to the incidence of nuchal cord and two case reports with fetal demise due to nuchal cord (1)(2)(3)(4)(5)(6)(7)(8). Th e reported incidence of nuchal cord varies, with the highest rates of 43% in the 13th to 16th gestational week and 8.3% in newborns (1,6).…”

“…Th e presence of nuchal cord seems to have no eff ect on the outcome of pregnancy in terms of birth weight, rate of stillbirth, or rate of vaginal delivery after induction (1)(2)(3)5). Compared to no entanglement or only one cord entanglement, two or more cord entanglements have been associated with an abnormal fetal heart rate pattern, requiring more low or midforceps application with a lower 1-minute Apgar score and an umbilical artery pH ≤ 7.10 without any adverse neonatal outcome (2).…”

“…Other than a thin and elongated neck, there were no dysmorphic features and no chromosomal abnormality on cytogenetic analysis. C ord entanglement is a common fi nding in utero; however, fetal demise resulting from nuchal cord entanglement is rare (1)(2)(3)(4)(5)(6)(7)(8). Th is report describes such a case.…”