Obstetric and Perinatal Outcome of Pregnancies with Nuchal Cord

To evaluate the obstetric and perinatal outcome of pregnancies with nuchal cord.

A prospective 1 year controlled study was conducted in the Department of Obstetrics and Gynaecology, Rajindra Hospital, Patiala. 50 women with term singleton pregnancy having nuchal cord and 50 women without nuchal cord as diagnosed on ultrasound were selected. They were allowed to go into spontaneous labour and followed till delivery. Outcome variables like mode of delivery, APGAR scores at 1 and 5 minute, meconium stained liquor, neonatal resuscitation were compared.

Results were analysed stastically using Pearson Chi-square method. Rate of normal vaginal delivery, LSCS and instrumental delivery in the study group was 82%, 12% and 6% respectively and in control group was 80%, 16% and 4% respectively indicating that nuchal cord as such had no significant impact on mode of delivery (df=2, p-value = 0.498) however, tight loop of cord which was found in 22% of cases was associated with 36.36% caesaerean and 36.36% normal vaginal delivery affecting the mode of delivery (p-value= 0.00). Average duration of second stage was 56.41± 26.64 minutes in study group and 55.44 ± 25.69 minutes in control group which was not significant. Nuchal cord had no significant impact on APGAR score (p-value = 0.50).

The presence of a nuchal cord was not associated with the risk of operative intervention and poor neonatal outcome. Such women require close monitoring during labour, preferably by continuous fetal electronic heart rate monitoring, however tight and multiple nuchal loops are associated with persistent variable or late deceleration affecting the mode of delivery and duration of second stage.