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Cord Around the Neck: Should It Be Severed at Delivery? A Randomized Controlled Study

Sadan, Oscar; Fleischfarb, Zehavit; Everon, Shmuel; Golan, Abraham; Lurie, Samuel

Obstetrical & Gynecological Survey: July 2007 - Volume 62 - Issue 7 - pp 429-430
doi: 10.1097/01.ogx.0000268655.61244.74
Obstetrics: Management of Labor, Delivery, and the Puerperium

It is not uncommon for the umbilical cord to become encircled around fetal parts—most often the neck. A single loop is present at this site in about 1 in 5 parturients. The encircled cord may be compressed at the time of delivery, compromising blood flow and the overall state of the fetus. This prospective randomized trial enrolled 60 women in whom encirclement was diagnosed by ultrasonography during active labor. In half the cases the cord was cut, while in 30 control cases it was left intact (but if loose was slipped over the head). There were no important demographic differences between women in the study and control groups.

Rates of induction or oxytocin augmentation of labor, the duration of membrane rupture, the length of the active phase and second stage of labor, and the use of epidural analgesia did not differ significantly in the study and control groups, and the same was the case for time in hospital. There also were no differences in 5-minute Apgar scores, the need for resuscitation, the occurrence of meconium-stained amniotic fluid, fetal heart rate patterns, or postdelivery umbilical cord pH values. Cord blood pH averaged 7.29 in the study group and 7.32 in the control group. The observed difference in pH was too small to be of clinical import.

This randomized trial failed to demonstrate any major clinical sequelae when a single loop of umbilical cord encircled the fetal neck during active labor. The authors’ practice is to separate the cord whenever it appears to be too tight. Otherwise, the cord is either slipped over the fetal head or left alone.

Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon and Sackler Medical School, Tel-Aviv University, Holon, Israel

Am J Perinatol 2007;24:61–64

© 2007 Lippincott Williams & Wilkins, Inc.