Prevalence and Immediate Neonatal Outcomes of Incidental Nuchal Cord at Birth Among Parturients With Singleton Uncomplicated Pregnancies at Kenyatta National Hospital in 2018: a Cross-sectional Study

Abstract

Background: A nuchal cord is a physiologic finding in 15 to 34% of pregnancies depending on gestation and geographical region. It is frequently blamed for adverse perinatal outcomes (perinatal asphyxia) in the absence of an obvious culprit. Studies done around it have shown conflicting findings in this regard. Objectives: To determine the prevalence of incidental nuchal cord at birth and its association with adverse immediate neonatal outcomes among singleton uncomplicated pregnancies at the Kenyatta National Hospital (KNH), Nairobi, Kenya. Methodology: This was a hospital-based cross-sectional study in KNH labour ward on 436 consecutively sampled women with uncomplicated term pregnancies. They were recruited in labour or just before Caesarean delivery. A brief questionnaire was administered and further data extracted from delivery records. Prevalence of incidental nuchal cord was obtained. Maternal and neonatal characteristics were summarized using proportions, percentages, means and standard deviation. Sub-group analysis was done for nuchal cord and no nuchal cord groups. Odd’s ratios with 95% confidence intervals were used to determine association between nuchal cord presence and immediate neonatal outcomes. Chi-square statistic and Student T-test were used to determine level of significance for categorical and continuous data respectively. Results: Nuchal cord prevalence was found to be 28.7%. Single and loose loops accounted for more than 80% of nuchal cord. There were no significant differences in maternal and neonatal characteristics between the nuchal cord and no nuchal cord groups. The odds of neonatal resuscitation was greater among the nuchal cord group than in the no nuchal cord group (OR=2.31, 95% CI=1.34-3.96, p=0.003).There was no significant association between presence of nuchal cord and other adverse neonatal outcomes (low Apgar score, meconium staining of liquor and NICU admission). Conclusion: Neonatal resuscitation is commoner among neonates delivered with nuchal cord. There are no significant differences between the two groups in meconium staining of liquor, low Apgar score, NICU admission and neonatal mortality. Recommendations: There should be anticipation and preparedness for neonatal resuscitation for neonates delivered with nuchal cord. However, presence of nuchal cord does not warrant need for Caesarean delivery. Key words: Nuchal cord, perinatal outcome, maternal, parturient