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  • Title: Nuchal cords are necklaces, not nooses.
    Author: Cohain JS.
    Journal: Midwifery Today Int Midwife; 2010; (93):46-8, 67-8. PubMed ID: 20397541.
    Abstract:
    Research based on 182,492 births, wielding statistical power to uncover even mild negative associations, showed that both single and multiple nuchal cords at the time of delivery are not associated with adverse perinatal outcomes. Nuchal cords are associated with higher birth weights and lower cesarean section rates than births without nuchal cords. Color Doppler ultrasound, intended specifically to diagnose nuchal cords hours before delivery, has diagnosed the presence of 35-80% of the nuchal cords found on delivery, and has a false positive rate of 19%. The rate of nuchal cords increases with increasing gestational weeks. Present technology cannot reliably predict the presence of a nuchal cord, tell whether a nuchal cord is tight, or determine anything regarding the likelihood of hypoxia, IUGR or stillbirth. Intervention for the supposed presence of single or multiple loops of nuchal cord or a true knot, suspected by ultrasound prenatally, is unjustified because diagnosis by ultrasound is unreliable and intervention involves greater risk to the baby than the nuchal cord. Since nuchal cords occur at rates of 30-34% at 40 weeks and are not associated with adverse perinatal outcomes, practitioners and women should consider their presence reassuring and normal. Given the common occurrence of nuchal cords and its very high association with a favorable outcome, scanning for nuchal cords appears to have no efficacy. Efforts to define and diagnose new antepartum "problems" continue to outstrip our ability to improve outcomes by diagnosing and "treating" newly defined problems.
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