Radiologic evidence of a nuchal arm in the breech-presenting fetus at the onset of labor: an indication for abdominal delivery

The occurrence of a nuchal arm during vaginal breech delivery is a potentially traumatic event associated with high perinatal morbidity and mortality. This problem usually cannot be anticipated and must be overcome immediately on diagnosis during the second stage of labor. The results of a retrospective analysis of radiologic studies of 115 cases of term singleton breech deliveries are presented here. A nuchal arm in the first stage of labor was diagnosed in five cases, an incidence of 4.35%. Of four vaginal breech deliveries, one case resulted in severe handicapping neonatal trauma. We suggest that radiologic diagnosis of a nuchal arm in the first stage of labor should indicate abdominal delivery.