Identification of nuchal cords during nonstress testing

A reactive nonstress test (NST) has been demonstrated to be an excellent predictor of fetal well-being. Unfortunately, some fetuses continue to be lost, perhaps secondary to umbilical cord accidents. While examining this problem, we noted a unique "double variable," or "W pattern," on the NSTs of fetuses found at delivery to have a nuchal cord. In a prospective study to examine the accuracy of predicting the presence of a nuchal cord, 200 consecutive patients undergoing antepartum fetal heart rate testing were monitored for the occurrence of a W pattern on their NSTs. One hundred percent of the women with a W pattern delivered infants with at least one nuchal cord. In addition, the W pattern was associated with a higher incidence of five-minute Apgar scores of less than 7. The ability to identify infants with nuchal cords prior to delivery may be beneficial in identifying infants at increased risk of unexpected fetal distress or death.