- Leonhard Schaffer, MD
Leonhard Schaffer, MD
- Associate Professor
- Head of Obstetrics
- Kantonsspital Baden AG
- Affiliated Hospital of the University of Zurich
- Roland Zimmermann, MD
Roland Zimmermann, MD
- Director & Professor
- Department Of Obstetrics
- University Hospital of Zurich, Switzerland
- Section Editors
- Susan M Ramin, MD
Susan M Ramin, MD
- Section Editor — Obstetrics
- Professor of Obstetrics and Gynecology
- Baylor College of Medicine
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
A loop of umbilical cord around the fetal neck (nuchal cord) is a common finding at delivery. Although available data are of low quality, the bulk of evidence suggests that nuchal cords are not associated with a statistically significant increase in the rate of any clinically important adverse fetal/neonatal event. In case reports and small case series, however, nuchal cords have been associated with adverse outcomes [1-3].
The term nuchal cord describes an umbilical cord that passes 360 degrees around the fetal neck. Nuchal cords can be classified as :
●Type A – A nuchal loop 360 degrees around the fetal neck where the placental end crosses over the umbilical end, entangling the neck in an unlocked pattern that can undo itself.
●Type B – A nuchal loop 360 degrees around the fetal neck where the placental end crosses under the umbilical end, entangling the neck in a locked pattern that cannot undo itself. This pattern can form a true knot when it passes down over the fetal body.
Nuchal cords can occur as single or multiple entanglements around the fetal neck. They may be loose or mildly to severely constricting. Disruption of the smooth contour of the fetal neck compressing the skin in that area, referred to as the "divot sign" , has been used to define tight nuchal cords .
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- Peregrine E, O'Brien P, Jauniaux E. Ultrasound detection of nuchal cord prior to labor induction and the risk of Cesarean section. Ultrasound Obstet Gynecol 2005; 25:160.
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- González-Quintero VH, Tolaymat L, Muller AC, et al. Outcomes of pregnancies with sonographically detected nuchal cords remote from delivery. J Ultrasound Med 2004; 23:43.
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- Rhoades DA, Latza U, Mueller BA. Risk factors and outcomes associated with nuchal cord. A population-based study. J Reprod Med 1999; 44:39.
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- Spellacy WN, Gravem H, Fisch RO. The umbilical cord complications of true knots, nuchal coils, and cords around the body. Report from the collaborative study of cerebral palsy. Am J Obstet Gynecol 1966; 94:1136.
- Greenwood C, Impey L. The association of nuchal cord with cerebral palsy is influenced by recording bias. Early Hum Dev 2002; 68:15.
- Nielsen LF, Schendel D, Grove J, et al. Asphyxia-related risk factors and their timing in spastic cerebral palsy. BJOG 2008; 115:1518.
- Katz ME, Bass WT, White LE. Dural sinus ectasia after prolonged nuchal cord encirclement. J Ultrasound Med 1992; 11:289.
- Bäz E, Zikulnig L, Hackelöer BJ, Hecher K. Abnormal ductus venosus blood flow: a clue to umbilical cord complication. Ultrasound Obstet Gynecol 1999; 13:204.
- NATURAL HISTORY
- ULTRASOUND DIAGNOSIS
- Sensitivity of ultrasound
- - Multiple versus single nuchal cords
- - Type a versus type b nuchal cords
- - Loose a versus tight nuchal cords
- POTENTIAL EFFECTS
- - Fetal demise
- - Impaired intrauterine growth
- - Abnormalities in tests for fetal assessment
- - Preterm delivery
- Nonreassuring fetal heart rate intrapartum
- - Short-term neonatal outcome
- Long-term risk of neurodevelopmental abnormalities
- PRENATAL SCREENING AND PREGNANCY MANAGMENT
- SUMMARY AND RECOMMENDATIONS