Antenatal course and perinatal outcome after ultrasound detection of triple nuchal cord: a case series

Abstract

Objective

To determine the antenatal course and perinatal outcome of pregnancies in which a triple nuchal cord was detected prenatally by ultrasound.

Methods

Singleton pregnancies presenting for ultrasound evaluation after 24 weeks of gestation were routinely screened for the presence of nuchal cord loops using two-dimensional and color-Doppler ultrasound. Fetuses with more than two nuchal cord loops were identified from our fetal medicine database and their ultrasound reports and medical records were reviewed.

Results

During the study period from July 2014 to February 2019, 10 singleton fetuses with triple nuchal cord were identified, for a prevalence of 1 in 506 or 0.2%. No cases of more than three nuchal cord loops were detected. No predisposing factors were identified. Cases detected after 36 weeks (n = 4) delivered by cesarean section after 37 weeks and the diagnosis of triple nuchal cord was confirmed in all of them. Cases detected before 36 weeks (n = 6) underwent fetal surveillance. Among these cases, the umbilical cord unraveled itself from around the fetal neck in at least one loop in 83% of these cases. Overall, eight (80%) of the neonates were delivered by cesarean section for different reasons; in only two, the sole indication for cesarean delivery was the presence of the triple nuchal cord. All the infants had a good perinatal outcome, although one newborn infant was small for gestational age.

Conclusions

Ultrasound detection of triple nuchal cord during late pregnancy was associated with good perinatal outcomes. However, this prenatal finding was also associated with a high rate of cesarean section. In preterm pregnancies, multiple loops will reduce spontaneously in the majority of cases, so expectant management is indicated. In term pregnancies, the decision regarding the optimal timing and mode of delivery should be discussed with the parents taking into account the individual clinical scenarios.

Keywords:

• Nuchal cord
• prenatal diagnosis
• prenatal ultrasound
• third-trimester ultrasound
• triple nuchal cord
• umbilical cord

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by an unrestricted research grant from the Sociedad Profesional de Medicina Fetal “Fetalmed” Ltda., Chile.