Nuchal cord incidence / outlook

17 Jun
As you walk in the door for your next shift, an ambo rolls in behind you, and on the stretcher is a young woman with a rather gravid abdomen.  You hear the word “crowning” as the medic speeds past you, so you grab some gloves and follow them to the elevator.  A quick peak reveals a baby flying towards you, but you notice the cord wrapped around the neck…  After making a mental note to change your scrubs later, what do you do now?
Study by Sheiner, et al.
166,318 deliveries during the study period, 14.7% had a nuchal cord, documented at birth (n=24,392). 
Although 1 min Apgar scores lower than 7 were more common in pregnancies with nuchal cord (4.8% vs. 4.4%; OR=1.1), these pregnancies actually had lower rates of 5 min Apgar scores less than 7 (0.5% vs. 0.7%; OR=0.8). 
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)
THEIR CONCLUSION – Nuchal cord is NOT associated with adverse perinatal outcome.
Methods to reduce nuchal cord:
  • Gently reduce with finger (if its loose enough to slip it over the head)
  • If this doesn’t work, then bring cord caudally over shoulders and deliver baby through cord and unwind it after delivery.
  • If this does not work, can perform somersault maneuver
    • Face pushed toward maternal thigh, rest of body delivers and somersaults out.
    • Once baby delivered can reduce.
  • If this does not work, you can simply clamp and cut cord while delivering.

Submitted by J. Andrick.

References: Arch Gynecol Obstet. Sheiner et al. 2006 May;274(2):81-3. Epub 2005 Dec 23.; picture 1; picture 2

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