Adverse outcomes of nonnuchal umbilical cord entanglement

Abstract

Objective: To evaluate perinatal effects of umbilical cord entanglement (UCE) of different body parts.

Methods: The database of a tertiary medical center was retrospectively searched for women who gave birth to a liveborn singleton newborn in 2014-2018. Those diagnosed postpartum with UCE were matched 1:10 with women who were not and compared for adverse obstetric and neonatal outcomes, overall and by site of entanglement.

Results: A total of 14 299 women were evaluated, of whom 1243 were diagnosed with UCE: 78.7% neck, 26% trunk, 6.7% limb. UCE was associated with lower birth weight percentile and higher rate of small for gestational age, but findings were significant only for neck and trunk UCE. On multivariate regression analysis adjusted for maternal age, parity, gestational age at birth, and history of cesarean delivery, UCE was an independent risk factor for nonreassuring fetal heart rate, labor induction, operative vaginal delivery, cesarean delivery, and meconium-stained amniotic fluid, but not for lower absolute birth weight/birth weight percentile, small for gestational age, low 1-min Apgar score, or neonatal asphyxia.

Conclusion: While fetuses with UCE might be more compromised during labor, they apparently recover shortly after birth. The impact on perinatal outcomes was similar for UCE of the neck and trunk and lower for UCE of the limb.

Keywords: adverse pregnancy outcomes; nonnuchal; nonreassuring fetal heart rate; nuchal cord; operative vaginal delivery; small for gestational age; umbilical cord entanglement.