To evaluate perinatal and long-term cardiovascular and respiratory morbidities of children born with nuchal cord.
A large population-based cohort analysis of singleton deliveries was conducted. Maternal and birth characteristics, as well as cardiovascular and respiratory morbidity incidence were evaluated. Kaplan–Meier survival curves were used to compare cumulative hospitalization incidence between groups. Cox regression models were used to control for possible confounders and follow-up length.
243,682 deliveries were included. Of them, 34,332 (14.1%) were diagnosed with nuchal cord. Perinatal mortality rate was comparable between groups (0.5 vs. 0.6%, p = 0.16). Kaplan–Meier survival curves demonstrated no significant differences in cumulative cardiovascular or respiratory morbidity incidence between groups (log rank p = 0.69 and p = 0.10, respectively). Cox regression models reaffirmed a comparable risk for hospitalization between groups (aHR = 0.99 (95% CI 0.85–1.14, p = 0.87) and aHR = 0.97 (95% CI 0.92–1.02, p = 0.28).
Nuchal cord is not associated with higher rate of perinatal mortality nor long-term cardiorespiratory morbidity.
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Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R. Nuchal cord is not associated with adverse perinatal outcome. Arch Gynecol Obstet. 2006;274:81–3.
Schäffer L, Burkhardt T, Zimmermann R, Kurmanavicius J. Nuchal cords in term and postterm deliveries—Do we need to know? Obstet Gynecol. 2005;106:23–8.
Kobayashi N, Aoki S, Oba MS, Takahashi T, Hirahara F. Effect of umbilical cord entanglement and position on pregnancy outcomes. Obstet Gynecol Int. 2015;2015:1–4. http://www.hindawi.com/journals/ogi/2015/342065/.
Clapp JF, Stepanchak W, Hashimoto K, Ehrenberg H, Lopez B. The natural history of antenatal nuchal cords. Am J Obstet Gynecol. 2003;189:488–93. http://linkinghub.elsevier.com/retrieve/pii/S0002937803003715.
Abramowicz JS, Sheiner E. Ultrasound in obstetrics: are we getting too good? Arch Gynecol Obstet. 2006;274:1–3.
Osak R, Webster KM, Bocking AD, Campbell MK, Richardson BS. Nuchal cord evident at birth impacts on fetal size relative to that of the placenta. Early Hum Dev. 1997;49:193–202.
Peesay M. Nuchal cord and its implications. Matern Health Neonatol Perinatol. 2017;3:28.
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;94:1136–42. https://doi.org/10.1016/0002-9378(66)90777-0.
Verdel MJC, Exalto N. Tight nuchal coiling of the umbilical cord causing fetal death. J Clin Ultrasound. 1994;22:64–6.
Clapp JF, Lopez B, Simonean S. Nuchal cord and neurodevelopmental performance at 1 year. J Soc Gynecol Investig. 1999;6:268–72.
Gutvirtz G, Wainstock T, Masad R, Landau D, Sheiner E. Does nuchal cord at birth increase the risk for cerebral palsy? Early Hum Dev. 2019;133:1–4. https://doi.org/10.1016/j.earlhumdev.2019.04.006.
Nielsen LF, Schendel D, Grove J, Hvidtjørn D, Jacobsson B, Josiassen T, et al. Asphyxia-related risk factors and their timing in spastic cerebral palsy. BJOG Int J Obstet Gynaecol. 2008;115:1518–28.
Sherer DM, Manning FA. Prenatal ultrasonographic diagnosis of nuchal cord(s)/ disregard, inform, monitor or intervene? Ultrasound Obstet Gynecol. 1999;14:1–8.
Wang G, Bove KE, Stanek J. Pathological evidence of prolonged umbilical cord encirclement as a cause of fetal death. Am J Perinatol. 1998;15:585–8.
Collins JH. Two cases of multiple umbilical cord abnormalities resulting in stillbirth: prenatal observation with ultrasonography and fetal heart rates. Am J Obstet Gynecol. 1993;168:125–8. https://doi.org/10.1016/S0002-9378(12)90899-6.
Henry E, Andres RL, Christensen RD. Neonatal outcomes following a tight nuchal cord. J Perinatol. 2013;33:231–4. https://doi.org/10.1038/jp.2012.79.
Jauniaux E, Ramsay B, Peellaerts C, Scholler Y. Perinatal features of pregnancies complicated by nuchal cord. Am J Perinatol. 1995;12:255–8.
De Jong F, Monuteaux MC, Van Elburg RM, Gillman MW, Belfort MB. Systematic review and meta-analysis of preterm birth and later systolic blood pressure. Hypertension. 2012;59:226–34.
Carr H, Cnattingius S, Granath F, Ludvigsson JF, Edstedt Bonamy AK. Preterm birth and risk of heart failure up to early adulthood. J Am Coll Cardiol. 2017;69:2634–42.
Inadera H, Inomata S, Mase D, Imamura H, Adachi Y, Yoshida T, et al. Effect of preterm birth on growth and cardiovascular disease risk at school age. Pediatr Int. 2015;57:1126–30.
Gutvirtz G, Wainstock T, Sheiner E, Landau D, Walfisch A. Pediatric cardiovascular morbidity of the early term newborn. J Pediatr. 2018;194:81–6.e2. https://doi.org/10.1016/j.jpeds.2017.09.060.
Walfisch A, Wainstock T, Beharier O, Landau D, Sheiner E. Early term deliveries and the risk of pediatric obstructive sleep apnoea in the offspring. Paediatr Perinat Epidemiol. 2017;31:149–56.
Larson JD, Rayburn WF, Harlan VL. Nuchal cord entanglements and gestational age. Am J Perinatol. 1997;14:555–7.
RM wrote the first draft of the paper. No honorarium, grant, or other form of payment was given to anyone to produce the paper. This study was conducted as part of the requirements for graduation from the Medical School of the Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel.
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Masad, R., Gutvirtz, G., Wainstock, T. et al. The effect of nuchal cord on perinatal mortality and long-term offspring morbidity. J Perinatol 40, 439–444 (2020). https://doi.org/10.1038/s41372-019-0511-x