Skip to main content

Nuchal cord (query bank)

Published: 13/01/2017

Question

Is there any relevance to detection of cord around neck on antenatal ultrasound?

Answer

The following recent study of pregnancy outcomes after antenatal detection of nuchal cord (NC) was identified:
In a study of 44 cases of prenatally diagnosed nuchal cord (Kesrouani): 18/44 cases (41%) underwent labor induction mostly as a result of parental anxiety. Primary cesarean rate was 34% (15/44), and 16% (7/44) had intrapartum FHR abnormalities with no impact for induction of labor. Instrumental vaginal delivery was used in 5 cases. IUGR was present in 7% (3/44), and none had IUFD.

Two studies have shown that nuchal cord affects nuchal cord thickness measurement (Ozkavukcu) and ductus venosus assessment (Plasencia).

Additionally, the following studies report outcomes for nuchal cord at time of delivery. Most report no association with adverse outcomes, except for one study by Wang:

  • A retrospective review of medical records of 1749 women, including 697 with a nuchal cord (Wang) concluded: “a nuchal cord is associated with perinatal complications, and male SGA fetuses with a nuchal cord have increased fetal distress risk during labor. Our results suggest that evaluations of fetal sex and body weight are also important in antenatal ultrasonography if a nuchal cord is found.
  • In a prospective cohort study, perinatal outcomes of 218 pregnancies complicated with NC were compared with 190 uncomplicated pregnancies (Akkaya) and the authors concluded “NC is not related with adverse perinatal outcomes such as acidosis and low APGAR scores.”
  • A retrospective study of 4,404 singleton term pregnancies which underwent spontaneous labour (Kong) found “Nuchal cord of any turns was not shown to be associated with intrauterine death, neonatal death, Apgar score <7 at 1 and 5 min. Only nuchal cord for three turns or more were associated with higher incidence of meconium-stained liquor, neonatal unit admission, suspected foetal distress during labour and emergency caesarean section.” The authors concluded that “Prenatal ultrasound scan for nuchal cord is, therefore, unnecessary and there should be no differences in management of nuchal cord of any turns.”
  • Narang et al studied 150 parturients with no, single or multiple loops and found: “Nuchal cord groups had significantly higher frequency of labor complications than no NC group, especially tight loops. Neonates with NC had significantly higher frequency of meconium-stained liquor, Apgar score <7 at 5 min, deranged biochemical markers, NICU transfer. However, none of the neonate had pH in acidosis range and majority were discharged in healthy condition”. They concluded “Routine antenatal ultrasound scan is not advisable, as mode of delivery and labor management does not change with detection of NC antenatally”

(Evidence level III)

 

References

  • Akkaya H; Buke B; Pekcan MK; Sahin K; Uysal G; Yegin GF; Avsar AF; Cagli F. Nuchal cord: is it really the silent risk of pregnancy?. Journal of Maternal-Fetal & Neonatal Medicine. 1-4, 2016 Sep 1. AbstractFull text available to RCOG Fellows, Members and Trainees.
  • Kesrouani A; Daher A; Maoula A; Attieh E; Richa S. Impact of a prenatally diagnosed nuchal cord on obstetrical outcome in an unselected population. Journal of Maternal-Fetal & Neonatal Medicine. 1-3, 2016 Apr 28. AbstractFull text available to RCOG Fellows, Members and Trainees.
  • Kong CW; Chan LW; To WW. Neonatal outcome and mode of delivery in the presence of nuchal cord loops: implications on patient counselling and the mode of delivery. Archives of Gynecology & Obstetrics. 292(2):283-9, 2015 Aug. AbstractFull text available to RCOG Fellows, Members and Trainees.
  • Narang Y; Vaid NB; Jain S; Suneja A; Guleria K; Faridi MM; Gupta B. Is nuchal cord justified as a cause of obstetrician anxiety?. Archives of Gynecology & Obstetrics. 289(4):795-801, 2014 Apr. AbstractFull text available to RCOG Fellows, Members and Trainees.
  • Ozkavukcu E; Haliloglu N. The effect of nuchal cord on nuchal fold thickness measured in the second trimester. European Journal of Radiology. 81(2):e123-5, 2012 Feb. Abstract.
  • Plasencia W; Lopez P; Esparza M; Garcia R; Barber MA; Garcia JA. Influence of nuchal cord on ductus venosus assessment at 11 to 13 + 6 weeks' gestation. Ultrasound in Obstetrics & Gynecology. 35(3):263-6, 2010 Mar. AbstractFull text available to RCOG Fellows, Members and Trainees.
  • Wang L; Kuromaki K; Kawabe A; Kikugawa A; Matsunaga S; Takagi A. Nuchal cord complication in male small for gestational age increases fetal distress risk during labor. Taiwanese Journal of Obstetrics & Gynecology. 55(4):568-74, 2016 Aug.

Search date

November 2016

Classification of evidence levels

  • Ia Evidence obtained from meta-analysis of randomised controlled trials.
  • Ib Evidence obtained from at least one randomised controlled trial.
  • IIa Evidence obtained from at least one well-designed controlled study without randomisation.
  • IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
  • III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
  • IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities

Disclaimer

The RCOG will not be liable for any special or consequential damages arising from the use or reliance on information contained within the query bank.