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Nuchal CordFrom: art fougner, md (evsono@pipeline.com)Mon Mar 10 13:46:51 2003
Presentation at the SMFM meeting - 451 Effects of nuchal cord on birth weight and immediate neonatal outcomes. JOAN MASTROBATTISTA1 MARY-CLARE DAY1 EDWARD YEOMANS1 SUSAN RAMIN1 ALFRED SOSA1 LARRY GILSTRAP III1 1University of Texas Health Science Center at Houston, Obstetrics, Gynecology and Reproductive Sciences, Houston, Texas OBJECTIVE: Spastic cerebral palsy has been reported to be associated with the presence of a nuchal cord. The purpose of this study was to determine if the presence of nuchal cord is associated with a decrease in birth weight or adverse immediate neonatal outcomes. STUDY DESIGN: Term neonates (37-42 weeks) with a documented nuchal cord were compared with term neonates without a nuchal cord over a 15-month period. Outcomes evaluated were birth weight, non-reassuring fetal heart rate (NRFHR) pattern, need for operative delivery, 5-minute Apgar score < 7, admission to the Level II nursery, and signs of neurologic dysfunction in the nursery. RESULTS: Over the 15-month period, 4630 term neonates were identified. Of these, 680 (14.7%) had a single nuchal cord (Group I), 92 (2%) had two or more loops of cord (Group II), and 3858 (83.3%) had no nuchal cord and served as controls (Group III). The mean birth weight of Group I was 3408 ± 459 g compared with 3432 ± 493 g for Group II and 3420 ± 488 g for controls (p = NS). There was no difference in the frequency of a NRFHR pattern among the three groups (2%, 3%, 3%). Moreover, there was no significant difference in cesarean or forceps deliveries, 5-minute Apgar score < 7, admission to Level II nursery, or signs of neurologic dysfunction. None of the neonates in Groups I or II had a 5-minute Apgar score of 3. CONCLUSION: Our study revealed no significant differences in birth weight or any of the other outcomes evaluated between term neonates with and those without nuchal cords. The presence of a nuchal cord at term appears to be associated with little short term risk and, importantly, does not increase the risk for operative delivery. Although we cannot address the risk for cerebral palsy, we found no association between the presence of a nuchal cord and neurologic dysfunction in the immediate newborn period. The wisdom of either searching for or reporting the finding of a nuchal cord as well as the significance of such a finding remains elusive. art
-- art fougner, md ich bin ein New Yorker
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