Cord Around the Foetal Neck: Course of Labour and Foetal Outcome

Abstract

Background: Cord around the neck is a common occurrence, frequently found in the labour room and in the operation theatre at the time of delivery. It causes panic and alarm for the obstetrician and is a source of worry for the parents if detected during the antenatal period. Mostly the parents choose to have a caesarean delivery to avoid any risk to the baby. Objective: To observe the labour, delivery and foetal outcome of undiagnosed cases of cord around foetal neck received in emergency with labour so as to have a supportive evidence to reduce the fear of general population against vaginal delivery in such cases. Design: A Descriptive study. Setting: This study was conducted in a teaching hospital affiliated with King Edward Medical University, Government Kot Khawaja Saeed Hospital Lahore in a period from Jan 2015 to Feb 2016. Methods: Booked or un-booked, 90 cases received with labour in the labour room, having singleton, term pregnancy and alive, healthy foetus were included in the study. All these cases were found to have cord around the neck after delivery (vaginal or operative). Routine careful management of labour and maintenance of all record on the labour charts was done. A prepared Proforma was filled at the end and specific points required like number of loops and tightness of the cord was specially mentioned in the cases qualified for inclusion criteria. Main Outcome measures: Foetal heart rate monitoring, meconium staining of liquor, mode of delivery and APGAR score of the newborn. Results: 35(38.6%) patients had decelerations and changes in heart rate on CTG. 10 patients (11.1%) had meconium staining of liquor and 25 (27.7%) had caesarean sections due to foetal distress and failed descent of foetal head. Vacuum extraction was done in 10 (11.1%) of the cases. Outlet Forceps were applied in 3 (3.3%). Spontaneous vaginal delivery was p ossible in 52 (57.7%) so total 65 patients (72.2%) had vaginal deliveries. Regarding APGAR Score of the neonates, lower A/S was found in those with tight loops of cord. In 14 (15.5%) of the neonates had 1 to 4 A/S at 1 minute. 5 to 6 A/S was found in 8(8.8%). And more than 7 A/S at birth was found in 01(1.1%) of the neonates with tight cords. Thirteen babies were admitted in the Neonatal unit and 6 were kept in the Hospital for more than 24 hours. Conclusion: Cases with cord around the neck can be delivered if they develop spontaneous labour but with strict intrapartum foetal monitoring and maintenance of partogram. There should be no delay in operative delivery if indicated. An antenatal diagnosis of cord around the neck does not justify an elective caesarean section.