MULTIPLE NUCHAL CORD ENTANGLEMENTS AND INTRAPARTUM COMPLICATIONS

OBJECTIVE: Our purpose was to evaluate the outcomes of pregnancies com plicated by a multiple (double, triple, or quadruple) nuchal cord enta nglement. STUDY DESIGN: Computerized data from our University Hospital perinatal database were reviewed between 1990 acid 1994. Only singlet on, vertex, acid term pregnancies undergoing labor were analyzed. Pati ents with active perinatal complications were eliminated to reduce bia s. Pregnancies with infants with either a single or no nuchal cord ent anglement served as comparison groups. A comparison of frequencies in the three groups was by chi(2) testing and a comparison of means by a two-tailed Student t test and analysis of variance. RESULTS: Of the 85 65 deliveries, the frequency of two or more cord entanglements at deli very was 3.8%. Compared with a single or no cord entanglement, pregnan cies with a multiple entanglement were more likely to exhibit an abnor mal fetal heart rate pattern during advanced labor (p <0.001) and to r equire low or midforceps application (p < 0.001). The study infants we re also more likely to have meconium (p = 0.013), a low 1-minute Apgar score (p < 0.001), and an umbilical artery pH less than or equal to 7 .10 (odds ratio 2.2, p = 0.013) than the controls, Rates of abruptio p lacentae, cesarean delivery, and 5-minute Apgar scores < 7 were no mor e common in the multiple entanglement than the control groups. CONCLUS ION: A multiple nuchal cord entanglement was associated with a greater risk of meconium, an abnormal fetal heart rate pattern during advance d labor, the need for operative vaginal delivery, and mild umbilical a rtery acidosis at birth; however, there was no added risk of an advers e neonatal outcome.