Ultrasonographic detection of nuchal cord: required or not

Vijayata Sangwan, Mukesh Sangwan, Sunita Siwach, Rajiv Mahendroo, Richa Kansal, Pinki Lakra

Abstract


Background: Nuchal cord is defined as an umbilical cord that passes 360 around the neck. From a long time nuchal cord is considered as one of the cause for birth asphyxia and neonatal complications. For ultrasonographic detection of nuchal cord and use of colour Doppler for the same is emphasized a lot in literature. On the other side studies are there that don’t support the ultrasonographic detection of nuchal cord. Practically also on one sides it makes the attendants more anxious and results in unnecessary caesarean section as well as results in malpractice also. This study was conducted to assess the requirement of nuchal cord detection at any phase of gestation.

Methods: This is a retrospective study conducted in the department of obstetrics & gynecology in a rural tertiary health care centre in one year duration. All the patients having nuchal cord at the time of delivery or caesarean section were included in the study. The case reports were analysed retrospectively for neonatal outcome and progress of labour.  

Results: The incidence of nuchal cord was 6.63%, irrespective of number of loops. The incidence of single loop was 5.32% double loop was 1.14% three loop was 0.17%. One patient had four loops of cord around neck and one patient had true knot in the cord but neonatal outcome was absolutely normal in both patients. The profile of patients was discussed in Table 1. A total of 85% patients were less than 30 year age group with literacy level of 65% and 55% patients were primigravida.20 patients developed prolonged labour, 13 patients among these responded to oxytocin and delivered normally and rest 07 underwent lower segment caesarean section for non-progress of labour or fetal distress. The duration of labour was found prolonged in patients w and triple nuchal cords. 53 (27.60%) fetus had unfavourable APGAR at birth, among these 20 had single tight loop of cord around neck, recovered soon as the cord was clamped and cut. Among rest 33 fetus 03 had three loops of cord around neck, 07 had two tight loops of cord around neck, in rest 23 fetus loops of cord were present besides that other factors like prematurity (11), severe preeclampsia (06), chorioamnionits (02) , antepartum hemorrhage (04) were also present, may be responsible for fetal distress.

Conclusions: Routine ultrasonographic nuchal cord detection is not required and should not alter obstetric management of the patient. 


Keywords


Nuchal cord, Ultrasonographic, Doppler

Full Text:

PDF

References


Narang Y, Vaid NB, Jain S, Suneja K, Faridi MMA, Gupta B. Is nuchal cord justified as a cause of obstetrician anxiety? Arch Gynecol Obstet. 2014 Apr;289(4):795-801.

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;25:160-4.

Gonzalez-Quintero VH, Tolyamat 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;23:43-7.

Henry E, Andres RL, Christensen RD. Neonatal outcome following tight nuchal cord. J Perinatol 2013;33(3):231-4.

Dhar KK, Ray SN, Dhall CI. Significance of nuchal cord. J Indian Med Assoc. 1995:939(12):451-3.

Larson JD, Rayburn WF, Crosby S, Thurnau GR. Multiple nuchal cord entanglements and intrapartum complications. Am J Obstet Gynecol. 1995;173(4):1228-31.

Ghi T, Emidio DL, Morandi R, Casadio P, PiluG. Nuchal cord entanglement and outcome of labour induction. J Prenat Med. 2007;1(4):57-60.