The Presence of Nuchal Cord and Need for Resuscitation at Birth in Term Newborns

Background: The presence of a nuchal umbilical cord is often a normal finding in a fetus. It may be associated with increased risk for adverse neonatal outcomes particularly if tight, coiled or knotted.

Objective: To examine the association between a pathological nuchal cord and need for resuscitation at birth in term newborns.

Methods: This was a retrospective study of an electronic medical record system for an Irish Maternity Hospital examined over twenty years. Inclusion criteria included newborns who delivered at ≥ 37 weeks gestation, inborn, and without major congenital anomalies. Logistic regression was utilized to model for factors independently associated with need for neonatal resuscitation at birth. The numbers of intrauterine deaths and newborn death within the first seven days of postnatal life were ascertained. A pathological nuchal cord was defined as “tight”, “coiled” and/or a “knot” present.

Results: The study included 140,613 newborns. Vaginal delivery occurred in 60.2% and instrumental/operative delivery in 26.1% of pregnancies. There were 357 intrauterine and/or neonatal deaths (0.25%). Newborn resuscitation, including positive pressure ventilation and/or more advanced resuscitation at birth, was necessitated in 2367 newborns (1.68%). A pathological nuchal cord was found in 3593 newborns (2.55%). A non-pathological nuchal cord was described in 36599 newborns (26%). A pathological cord around the neck was found to be independently associated with need for resuscitation at birth adjusting for mode of delivery, multiple births, and meconium stained amniotic fluid (OR 1.90, 95% CI 1.56 – 2.32).

Conclusions: A pathological nuchal umbilical cord including either a knot, tightness or coiling was found to be associated with need for newborn resuscitation at birth in term pregnancies. This study was limited by its retrospective nature and the infrequency of intrauterine death and/or newborn mortality. Its strength is the large sample size.