Neonatal outcome and mode of delivery in the presence of nuchal cord loops: implications on patient counselling and the mode of delivery.

PURPOSE: To review and compare the foetal outcomes and mode of delivery in patients with nuchal cord for single loop, double loops, and multiple loops.

METHODS

A retrospective study of 4,404 singleton term pregnancies which underwent spontaneous labour was conducted. The patients were classified into five groups: without nuchal cord, nuchal cord of any turns, nuchal cord for 1 turn, nuchal cord for 2 turns and nuchal cord for 3 turns or above. The perinatal outcomes and mode of delivery were then compared.

RESULTS

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.

CONCLUSIONS

Only nuchal cord for 3 turns or more was associated with higher incidence of suspected foetal distress. However, the Apgar scores were not affected. Therefore, nuchal cord of any turns was not associated with adverse foetal outcomes. Prenatal ultrasound scan for nuchal cord is, therefore, unnecessary and there should be no differences in management of nuchal cord of any turns.