Perinatal outcome in pregnancies with nuchal cord: prospective cross-sectional study at tertiary care institute

Zaneta Dias, Shailesh Kore


Background: The umbilical cord around the neck of fetus at the time of birth is nuchal cord (NC). NC is blamed as a major cause of fetal distress and perinatal mortality. The present study was undertaken to found out the incidence of nuchal cord at delivery and its perinatal outcomes in babies born with NC.

Methods: Total 500 low risk women delivered either vaginally or abdominally after 34 completed weeks of gestation were included in the study. Cases with NC at the time of delivery were taken as study group and the cases which did not have NC served as control group. Various obstetric characteristics and perinatal outcome were studied.

Results: The frequency of NC found was 35.6% of all the deliveries. Women with age between 21-25 years showed the maximum presence of NC (11.4%) and NC mostly seen between 38-40 weeks of gestation (24.8%). Presence of NC had no statistical significance on the maternal age, parity, period of gestation, mode of delivery, presence of meconium stained amniotic fluid and fetal distress. Prolonged duration of labour was seen in the presence of NC. The presence of NC was directly proportional to the length of cord and umbilical cord coiling. Perinatal outcome of babies in terms of Apgar score and seen as NICU admissions rate were not statistically significant. Tight NC had a poor Apgar score needed more intensive care.

Conclusions: NC is a common finding at the time of delivery. The present study suggests that NC is not associated with significant perinatal outcome.


Umbilical cord, Nuchal cord, Perinatal outcome, Fetal distress, Apgar score, NICU

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Crawford JS. Cord Round the Neck. Acta Paediatrica. 1962;51(5):594-603.

Peesay M. Nuchal cord and its implications. Matern Health Neonatol Perinatol. 2017;3:28.

Clapp JF, Stepanchak W, Hashimoto K, Ehrenberg H, Lopez B. The natural history of antenatal nuchal cords. Am J Obstet Gynecol. 2003;189(2):488-93.

Miser WF. Outcome of infants born with nuchal cords. J Fam Pract. 1992;34(4):441-5.

Miser WF. Outcome of infants born with nuchal cords. Obstet Gynecol Surv. 1992;47(11):767-9.

Singh G, Sidhu K. Nuchal Cord: A Retrospective Analysis. Med J Armed Forces India. 2008;64(3):237-40.

Collins JH, Collins CL, Weekwerth SR, De Angelis L. Nuchal cords: timing of prenatal diagnosis and duration. Am J Obstet Gynecol. 1995;17:768.

Jauniaux E, Ramsay B, Peellaerts C, Scholler Y. Perinatal features of pregnancies complicated by nuchal cord. Am J Perinatol. 1995;12(4):255-8.

Rhoades DA, Latza U, Mueller BA. Risk factors and outcomes associated with nuchal cord. A population-based study. J Reproduc Med. 1999;44(1):39-45.

Clapp JF, Stepanchak W, Hashimoto K, Ehrenberg H, Lopez B. The natural history of antenatal nuchal cords. Am J Obstet Gynecol. 2003;189(2):488-93.

Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R. Nuchal cord is not associated with adverse perinatal outcome. Arch Gynecol Obstet. 2005;274(2):81-3.

Gupta J, Sharma R and Gupta A. To study the effect of nuchal cord on perinatal outcome and mode of delivery in uncomplicated pregnancies. Int J Clinic Obstet Gynaecol. 2020;4(5):137-43.

Reed R, Barnes M, Allan J. Nuchal cords: Sharing the evidence with parents. Brit J Midwif. 2009;17(2):106-9.

Chatterjee AK, Sengupta. Cord around the neck of the fetus. A study on 101 cases. J Obs Gyn India. 1989;39:660-4.

Shrestha NS, Singh N. Nuchal cord and perinatal outcome, Kathmandu University Medical Journal 2007;5(3):360-3.

Sonawane PK, Bhadra DM. Comparative study of maternal and perinatal outcome in pregnancies with and without umbilical cord around foetal neck. Int J Reprod Contracept Obstet Gynecol. 2019;8:1096-9.

Begum AA, Sultana H, Hasan R, Ahmed M. A clinical study of fetal outcome in cases of nuchal cord. JAFMC Bangladesh. 2011;7(1):25-7.

Mastrobattista JM, Hollier LM, Yeomons ER, Ramin SM. Day MC, Sosa A et al 3rd. Effects of nuchal cord on birthweight and immediate neonatal outcomes. Am J Perinatol. 2005;22(2):83-5.

Peregrine E, O’Brien P, Jauniaux E. Ultrasound detection of nuchal cord prior to labour induction and the risk of caesarean section. Ultrasound Obstet Gynecol. 2005;25(2):160-4.

González-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 Ultrasound Med. 2004;23(1):43-7.

Schreiber H, Daykan Y, Arbib N, Markovitch O, Berkovitz A, Biron-Shental T. Adverse pregnancy outcomes and multiple nuchal cord loops. Arch Gynecol Obstet. 2019;300(2):279–83.

Vasa R, Dimitrov R, Patel S. Nuchal cord at delivery and perinatal outcomes: Single-center retrospective study, with emphasis on fetal acid-base balance. Pediatr Neonatol. 2018;59(5):439-47.

Akkaya H, Büke B, Pekcan MK, Şahin K, Uysal G, Yeğin GF, et al. Nuchal cord: is it really the silent risk of pregnancy? J Matern Fetal Neonatal Med [Internet]. 2017;30(14):1730-3.

Walla T, Rothschild MA, Schmolling JC, Banaschak S. Umbilical cord entanglement’s frequency and its impact on the newborn. Int J Legal Med [Internet]. 2018;132(3):747-52.

Ashok Phadol V, Sharad Naik A, Amit Naik S. Nuchal cord and perinatal outcome in a rural hospital: a case control study. J Evol Med Dent Sci. 2016;5(53):3531-5.