THE NUCHAL CORD

THE NUCHAL CORD

Introduction
Nuchal cord is when the umbilical cord that passes 360 degrees (coiled) around the fetal neck. Many parents are concerned that their baby will be born with the umbilical cord around the neck (nuchal cord), and associate this scenario with complications including stillbirth, fetal distress or neonatal morbidity. About one third of babies are born with a nuchal cord. Nuchal cord can be classified according to the number of cord coiling and tightness. Majority of nuchal cord are single loop (20.6%) and loose.

The diagnosis of nuchal cord is usually made following abnormal CTG changes (fetal distress pattern) or upon delivery of the baby’s head. Lately, nuchal cord can be detected by antenatal ultrasound.
The clinical evidence
The risk of neonatal mortality associated with nuchal cord is rare. It is reported at 0.4-0.6%.

Earlier evidence shows nuchal cord is associated with adverse outcome, including fetal demise,[8] physiological or neurodevelopmental impairment,[9–13] and increased risk of cerebral palsy[13,14]

In more recent studies, no significant difference in the risk of operative deliveries and neonatal outcome was demonstrated when compared to baby born without nuchal cord. These studies claim to be more accurate as they are from a larger sample size and better designed.

Implications for practice
The current evidence has shown that a prenatal diagnosis of nuchal cord is unlikely to be helpful in uncomplicated pregnancy. In presence of associated risk factors, an increased surveillance using fetal movement chart, amniotic fluid assessment and CTG maybe indicated.

Summary
Even though nuchal cord is a common occurrence, they rarely result in the death of a baby. Despite this fact, there is no consolation to those who have experienced the horror of their child’s death because when you are the statistic, it doesn’t matter how rarely something occurs. The parents’ concern and anxiety must not be overlooked.

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