Nuchal cord is not associated with adverse perinatal outcome

Objective: The present study was aimed at evaluating the outcome of pregnancies with nuchal cord. Methods: A retrospective population-based study of all deliveries during the years 1988–2003 in a tertiary medical center was conducted. Immediate perinatal outcome of patients with and without nuchal cord was compared. Results: Of 166,318 deliveries during the study period, 14.7% had a nuchal cord, documented at birth (n=24,392). Higher rates of labor induction and non-reassuring fetal heart rate patterns were noted among pregnancies with nuchal cord as compared with the control group (30.1% vs. 24.2%; OR=1.3, 95% CI 1.3–1.4, P<0.001 and 4.5% vs. 2.6%; OR=1.8, 95% CI 1.6–1.9, P<0.001; respectively). The cesarean delivery rate was significantly lower among pregnancies with nuchal cord (11.5% vs. 12.7%; OR=0.9, 95% CI 0.8–0.9, P=0.001). Although 1 min Apgar scores lower than 7 were more common in pregnancies with nuchal cord (4.8% vs. 4.4%; OR=1.1, 95% CI 1.01–1.2, P=0.008), these pregnancies actually had lower rates of 5 min Apgar scores less than 7 (0.5% vs. 0.7%; OR=0.8, 95% CI 0.6–0.9, P=0.004). Likewise, the perinatal mortality rate was significantly lower in pregnancies with nuchal cord as compared with the comparison group (11/1,000 vs. 16/1,000; OR=0.7, 95% CI 0.6–0.8, P=0.001). Conclusions: Nuchal cord is not associated with adverse perinatal outcome. Thus, labor induction in such cases is probably unnecessary.Presented in part at the 15th World Congress on Ultrasound in Obstetrics and Gynecology 25–29 September 2005, Vancouver, Canada.