FETAL OUTCOME;

EFFECTS OF NUCHAL CORD VS WITHOUT CORD AROUND THE NECK ON MODE OF DELIVERY

Abstract

Objectives: To compare the effect of nuchal cord versus without cord around
the neck on mode of delivery and fetal outcome. Study design: Case control comparative
study. Period: 1st August 2013 to 31st March 2014. Setting: Gyn /Obs Department at Sir Syed
Hospital Karachi. Material and Methods: A comparative study was carried out on 2 groups
of parturient ladies. The study group comprised of those ladies who at the time of delivery
(vaginal delivery/caesarean-section) had clinically cord around the neck while the other group
(control) did not have nuchal cord. Duration of labour, mode of delivery were noted. Perinatal
outcome was measured in terms of Apgar score and NICU admission. High risk pregnancies
were excluded from the study. Result: Incidence of nuchal cord at the time of delivery was
22.7%. A high rate of caesarean delivery observed in study group as compared to control
group (70 % vs 40%) (P value 0.00006). Fetal heart rate irregularities & meconium stained
liquor finding was not significantly different in two groups (p< 0.161) & (p<0.169) respectively.
Similarly fetal outcome measured in terms of Apgar score at 1 & 5 min & NICU admission
was also not significantly different between the two groups. Conclusion: A significant high
rate of caesareans section rate was observed in the study group mainly due to fetal distress
(FHR irregularities). This means cord around the neck is a risk factor & needs extra monitoring
specially through intermittent CTG monitoring during labour so that fetal distress can be picked
up early & emergency caesarean section can be performed to avoid fetal compromise.