Effects of Nuchal Cord on Maternal & Foetal Outcome.

ABSTRACT

Umbilical cord is the connecting link between the foetus and the placenta through which foetal blood flows to and from the placenta. It extends from the foetal umbilicus to the foetal surface of the placenta. Excessively long cords are linked with cord entanglement. Nuchal cord occurs when umbilical cord gets wrapped around foetal neck 3600. Single loop around neck is reported in 20-34% cases. Cord compression is one of the postulated factors for birth asphyxia. It has become a cause of concern for rising primary C Section rate. We wanted to determine the actual threat nuchal cord poses to the mother as well as to the foetus and identify various factors which should be considered for safe delivery in these patients. METHODSThis study was conducted in the Department of Health and Medical Education, Sub-District Hospital, Akhnoor, J & K. We included 100 cases in the test group in which nuchal cord was identified during delivery, delivered either vaginally or by C section. These cases were compared with 100 controls delivered without nuchal cord. We had to observe 462 patients for finding out 100 cases. Incidence of nuchal cord in our study is 21.64%. Patients profile was noted on proforma and various variables were compared such as age, parity, gestational age, mode of delivery, duration of labour, length of cord, number of loops and prior USG detection of cord were noted in every case. Foetal outcome as observed in terms of gender, birth weight and Apgar score was recorded. RESULTSMost of the patients belonged to the age group 21-25 years with a mean age of 25.56 years. Incidence of nuchal cord is 21.64%. As the number of turns increased, incidence fell progressively, but as the number of loops increased length of cord also increased. Only 36 loops were pre detected on USG. Maximum number of patients had normal vaginal delivery in both groups, but the rate of C section was higher in test group and difference was statistically significant (0.028). When variables of newborn were compared, no significant difference was seen in sex and weight of the baby. Meconium stained liquor was more in nuchal cord group and although low Apgar score was more in nuchal cord group, the difference was not statistically significant. CONCLUSIONSNuchal cord is a common feature observed during delivery and is seen almost in 20-25% cases. Ante natal diagnosis of nuchal cord is possible with USG and colour doppler imaging. Elective C section for nuchal cord is a wrong practice. Patients should be assessed holistically including age, parity, gestational age, Bishop score and signs of foetal distress. Vigilant ante partum and intra partum monitoring is required in every case. Nuchal cord is potential cause of perinatal distress and rarely significant long-term neurodevelopmental consequences are seen in the foetus.