Nuchal cord

Nuchal cord
Baby in the uterus with umbilical cord wrapped around its neck and arm
Pronunciation
  • /ˈnʲu.kəl/
SpecialtyObstetrics, pediatrics
SymptomsDuskiness of face, facial petechia, bleeding in the whites of the eye[1]
ComplicationsMeconium, respiratory distress, anemia, stillbirth[1]
Diagnostic methodSuspect based on in the babies heart rate during labor, ultrasound[1]
Differential diagnosisBirth asphyxia[1]
TreatmentUnwrapping the cord during delivery or if this is not possible clamping and cutting the cord[2]
PrognosisUsually good[1]
Frequency25% of deliveries[2]

A nuchal cord is when the umbilical cord becomes wrapped around the fetus's neck.[1] Symptoms present in the baby shortly after birth from a prior nuchal cord may include duskiness of face, facial petechia, and bleeding in the whites of the eye.[1] Complications can include meconium, respiratory distress, anemia, and stillbirth.[1] Multiple wraps are associated with greater risk.[3]

The diagnosis may be suspected if there is a decrease in the baby's heart rate during delivery.[1] Nuchal cords are typically checked for by running the finger over the baby's neck once the head has delivered.[4] Ultrasound may pick up the condition before labor.[1]

If detected during delivery, management includes trying to unwrap the cord or if this is not possible clamping and cutting the cord.[2] Delivery can typically take place as normal and outcomes are generally good.[5][1] Rarely long term brain damage or cerebral palsy may occur.[1][6] Nuchal cords occur in about a quarter of deliveries.[2] The condition has been described at least as early as 300 BC by Hippocrates.[1]

  1. ^ a b c d e f g h i j k l m Peesay M (6 December 2017). "Nuchal cord and its implications". Maternal Health, Neonatology and Perinatology. 3 (1): 28. doi:10.1186/s40748-017-0068-7. PMC 5719938. PMID 29234502.
  2. ^ a b c d "Nuchal Cord". Merck Manuals Consumer Version. June 2018. Archived from the original on 9 April 2021. Retrieved 2 October 2018.
  3. ^ Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T (March 2009). "Ultrasound diagnosis and management of umbilical cord abnormalities". Taiwanese Journal of Obstetrics & Gynecology. 48 (1): 23–7. doi:10.1016/S1028-4559(09)60031-0. PMID 19346188.
  4. ^ Ferri FF (2014). Ferri's Clinical Advisor 2015 E-Book: 5 Books in 1. Elsevier Health Sciences. p. e23. ISBN 9780323084307.
  5. ^ Adams JG (2012). Emergency Medicine E-Book: Clinical Essentials (Expert Consult -- Online). Elsevier Health Sciences. p. 1064. ISBN 978-1455733941.
  6. ^ MacLennan AH, Thompson SC, Gecz J (December 2015). "Cerebral palsy: causes, pathways, and the role of genetic variants" (PDF). American Journal of Obstetrics and Gynecology. 213 (6): 779–88. doi:10.1016/j.ajog.2015.05.034. PMID 26003063.

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