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Am J Perinatol 2020; 37(04): 378-383
DOI: 10.1055/s-0039-1679866
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Electronic Fetal Monitoring and Neonatal Outcomes when a Nuchal Cord Is Present at Delivery

Ebony B. Carter
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
Cheryl S. Chu
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
Zach Thompson
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
Methodius G. Tuuli
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
George A. Macones
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
Alison G. Cahill
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
› Author Affiliations
Funding This study is supported by the National Institute of Child Health and Human Development (NICHD) grant number R01H061619–04 (PI: Alison Cahill). E.B.C. was supported by a National Institutes of Health T32 training grant (5T32HD055172–05) and the Robert Wood Johnson Foundation #74250. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of the Robert Wood Johnson Foundation.
Further Information

Publication History

03 August 2018

12 January 2019

Publication Date:
28 February 2019 (online)

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Abstract

Objective This study aimed to determine the association between nuchal cord, electronic fetal monitoring parameters, and adverse neonatal outcomes.

Study Design This was a prospective cohort study of 8,580 singleton pregnancies. Electronic fetal monitoring was interpreted, and patients with a nuchal cord at delivery were compared with those without. The primary outcome was a composite neonatal morbidity index. Logistic regression was used to adjust for confounders.

Result Of 8,580 patients, 2,071 (24.14%) had a nuchal cord. There was no difference in the risk of neonatal composite morbidity in patients with or without a nuchal cord (8.69 vs. 8.86%; p = 0.81). Nuchal cord was associated with category II fetal heart tracing and operative vaginal delivery (OVD) (6.4 vs. 4.3%; p < 0.01).

Conclusion Nuchal cord is associated with category II electronic fetal monitoring parameters, which may drive increased rates of OVD. However, there is no significant association with neonatal morbidity.

Keywords

nuchal cord - neonatal morbidity - electronic fetal monitoring - fetal heart rate