Cord around the neck: should it be severed at delivery? A randomized controlled study

Area of Science:

• Obstetrics and Gynecology
• Perinatology
• Fetal Medicine

Background:

• Umbilical cord encirclement, particularly around the fetal neck (nuchal cord), is a common occurrence during pregnancy and labor.
• The incidence of nuchal cords varies, with single loops being more frequent than multiple loops.
• Concerns exist regarding potential adverse effects on fetal well-being and neonatal outcomes.

Purpose of the Study:

• To evaluate the safety and impact of intentionally severing a single umbilical cord loop around the fetal neck after delivery of the anterior shoulder.
• To compare neonatal outcomes between a group where the nuchal cord was cut and a control group where it was left intact.

Main Methods:

• A prospective, randomized controlled trial involving 60 women with diagnosed single nuchal cords.
• The study group (30 women) had the umbilical cord intentionally severed after anterior shoulder delivery.
• The control group (30 women) had the umbilical cord left intact.
• Outcomes assessed included cord pH, Apgar scores, need for resuscitation, and hospitalization length.

Main Results:

• No statistically significant differences were observed between the study and control groups in perinatal variables.
• Key outcomes such as meconium-stained amniotic fluid, fetal heart rate patterns, 5-minute Apgar scores, and umbilical cord pH showed no adverse changes.
• Umbilical cord pH values were comparable (7.29 ± 0.07 in the study group vs. 7.32 ± 0.06 in the control group).

Conclusions:

• Intentional severing of a single umbilical cord loop around the neck after delivery of the anterior shoulder is a safe practice.
• Leaving an intact single nuchal cord also results in no detectable adverse perinatal outcomes.
• The management decision for single nuchal cords in this specific scenario does not appear to influence immediate neonatal well-being.