J Clin Gynecol Obstet

Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc

Journal website http://www.jcgo.org

Original Article

Volume 8, Number 2, June 2019, pages 48-53

The Presence of Nuchal Cord Does Not Hinder the Normal Progression of Labor

**Table 1.** Presence or Absence of Nuchal Cord in Nulliparous and Multiparous Women
	Nulliparas (N = 2,277)	Multiparas (N = 2,548)	P-value
P-value: Mann-Whitney U test.
No nuchal cord	1,619 (71.1%)	1,828 (71.7%)	0.599
Single nuchal cord	559 (24.5%)	616 (24.2%)
Multiple nuchal cord	99 (4.3%)	104 (4.1%)

Table 1. Presence or Absence of Nuchal Cord in Nulliparous and Multiparous Women

Nulliparas (N = 2,277)

Multiparas (N = 2,548)

P-value

P-value: Mann-Whitney U test.

No nuchal cord

1,619 (71.1%)

1,828 (71.7%)

0.599

Single nuchal cord

559 (24.5%)

616 (24.2%)

Multiple nuchal cord

99 (4.3%)

104 (4.1%)

**Table 2.** Characteristics of Pregnant Women With or Without Nuchal Cord
Nulliparas	No NC (N = 1,619)	Single NC (N = 559)	Multiple NC (N = 99)	P-value
Maternal age	29.9 ± 4.5	30.0 ± 4.2	30.7 ± 4.6	0.165	> 0.999	0.186
Maternal height (cm)	158.4 ± 5.2	158.1 ± 5.2	159.0 ± 5.1	0.174	0.476	0.888
Maternal weight (kg)	50.7 ± 6.5	50.7 ± 7.1	51.6 ± 7.9	0.476	> 0.999	0.652
BMI (kg/m²)	20.2 ± 2.3	20.3 ± 2.5	20.4 ± 2.7	0.597	> 0.999	> 0.999
Weight gain (kg)	10.7 ± 3.5	10.8 ± 3.5	10.2 ± 3.4	0.277	> 0.999	0.553
Gestational age (days)	277.6 ± 6.8	277.9 ± 6.8	277.3 ± 7.6	0.609	> 0.999	> 0.999
Cord length (cm)	53.6 ± 10.5	61.1 ± 10.2	71.1 ± 12.7	0.000	0.000	0.000
Neonatal weight (g)	3,014 ± 349	3,007 ± 335	2,872 ± 378	0.000	> 0.999	0.000
AS at 1 min	9 (9, 10)	9 (9, 10)	9 (9, 10)	0.009*	0.017^#	0.279^#
AS at 5 min	10 (10, 10)	10 (10, 10)	10 (10, 10)	0.112*	0.868^#	0.154^#
UA pH	7.31 ± 0.07	7.30 ± 0.07	7.31 ± 0.06	0.012	0.009	> 0.999
UA base excess	-3.2 ± 3.0	-3.6 ± 3.4	-3.9 ± 2.6	0.059	0.251	0.174
Epidural use (N)	98 (6.3%)	36 (6.6%)	10 (10.1%)	0.296**	> 0.999^##	0.419^##
Data are presented as mean ± standard deviation; median (interquartile range: 25th percentile, 75th percentile). NC: nuchal cord; BMI: body mass index; UA: umbilical artery; AS: Apgar score. P-value: one-way analysis of variance. Kruskal-Wallis test. *Fisher’s exact test (for all). Unpaired t-test with Bonferroni correction. ^#Mann-Whitney U test with Bonferroni correction. ^##Fisher’s exact test with Bonferroni correction (no NC vs. single or multiple NC).
Maternal age	32.4 ± 4.1	32.0 ± 4.0	32.4 ± 4.5	0.178	0.194	> 0.999
Maternal height (cm)	158.2 ± 5.1	158.1 ± 5.3	158.0 ± 5.5	0.799	> 0.999	> 0.999
Maternal weight (kg)	51.4 ± 7.1	51.7 ± 7.2	51.5 ± 7.4	0.753	> 0.999	> 0.999
BMI (kg/m²)	20.5 ± 2.6	20.7 ± 2.6	20.6 ± 2.6	0.535	0.795	> 0.999
Weight gain	10.3 ± 3.4	10.4 ± 3.1	10.4 ± 3.2	0.538	0.824	> 0.999
Gestational age (days)	275.2 ± 6.3	274.6 ± 6.3	275.7 ± 7.4	0.071	0.103	> 0.999
Cord length (cm)	54.9 ± 10.3	61.7 ± 9.8	71.0 ± 10.7	0.000	0.000	0.000
Neonatal weight (g)	3,083 ± 345	3,066 ± 338	2,999 ± 301	0.038	0.837	0.046
AS at 1 min	10 (9, 10)	9 (9, 10)	9 (9, 10)	0.000*	0.000^#	0.017^#
AS at 5 min	10 (10, 10)	10 (10, 10)	10 (10, 10)	0.001*	0.003^#	0.038^#
UA pH	7.34 ± 0.06	7.34 ± 0.08	7.32 ± 0.09	0.021	0.759	0.014
UA base excess	-1.0 ± 2.6	-1.3 ± 2.9	-2.0 ± 3.6	0.004	0.124	0.010
Epidural use (N)	50 (2.7%)	17 (2.8%)	2 (1.9%)	> 0.999**	> 0.999^##	> 0.999^##

Table 2. Characteristics of Pregnant Women With or Without Nuchal Cord

Nulliparas

No NC (N = 1,619)

Single NC (N = 559)

Multiple NC (N = 99)

P-value

For all

No NC vs. single NC

No NC vs. multiple NC

Maternal age

29.9 ± 4.5

30.0 ± 4.2

30.7 ± 4.6

0.165

> 0.999

0.186

Maternal height (cm)

158.4 ± 5.2

158.1 ± 5.2

159.0 ± 5.1

0.174

0.476

0.888

Maternal weight (kg)

50.7 ± 6.5

50.7 ± 7.1

51.6 ± 7.9

0.476

> 0.999

0.652

BMI (kg/m²)

20.2 ± 2.3

20.3 ± 2.5

20.4 ± 2.7

0.597

> 0.999

Weight gain (kg)

10.7 ± 3.5

10.8 ± 3.5

10.2 ± 3.4

0.277

> 0.999

0.553

Gestational age (days)

277.6 ± 6.8

277.9 ± 6.8

277.3 ± 7.6

0.609

> 0.999

Cord length (cm)

53.6 ± 10.5

61.1 ± 10.2

71.1 ± 12.7

0.000

Neonatal weight (g)

3,014 ± 349

3,007 ± 335

2,872 ± 378

0.000

> 0.999

0.000

AS at 1 min

9 (9, 10)

0.009*

0.017^#

0.279^#

AS at 5 min

10 (10, 10)

0.112*

0.868^#

0.154^#

UA pH

7.31 ± 0.07

7.30 ± 0.07

7.31 ± 0.06

0.012

0.009

> 0.999

UA base excess

-3.2 ± 3.0

-3.6 ± 3.4

-3.9 ± 2.6

0.059

0.251

0.174

Epidural use (N)

98 (6.3%)

36 (6.6%)

10 (10.1%)

0.296**

> 0.999^##

0.419^##

Multiparas

No NC (N = 1,828)

Single NC (N = 616)

Multiple NC (N = 104)

P-value

For all

No NC vs. single NC

No NC vs. multiple NC

Data are presented as mean ± standard deviation; median (interquartile range: 25th percentile, 75th percentile). NC: nuchal cord; BMI: body mass index; UA: umbilical artery; AS: Apgar score. P-value: one-way analysis of variance. *Kruskal-Wallis test. **Fisher’s exact test (for all). Unpaired t-test with Bonferroni correction. ^#Mann-Whitney U test with Bonferroni correction. ^##Fisher’s exact test with Bonferroni correction (no NC vs. single or multiple NC).

Maternal age

32.4 ± 4.1

32.0 ± 4.0

32.4 ± 4.5

0.178

0.194

> 0.999

Maternal height (cm)

158.2 ± 5.1

158.1 ± 5.3

158.0 ± 5.5

0.799

> 0.999

Maternal weight (kg)

51.4 ± 7.1

51.7 ± 7.2

51.5 ± 7.4

0.753

> 0.999

BMI (kg/m²)

20.5 ± 2.6

20.7 ± 2.6

20.6 ± 2.6

0.535

0.795

> 0.999

Weight gain

10.3 ± 3.4

10.4 ± 3.1

10.4 ± 3.2

0.538

0.824

> 0.999

Gestational age (days)

275.2 ± 6.3

274.6 ± 6.3

275.7 ± 7.4

0.071

0.103

> 0.999

Cord length (cm)

54.9 ± 10.3

61.7 ± 9.8

71.0 ± 10.7

0.000

Neonatal weight (g)

3,083 ± 345

3,066 ± 338

2,999 ± 301

0.038

0.837

0.046

AS at 1 min

10 (9, 10)

9 (9, 10)

0.000*

0.000^#

0.017^#

AS at 5 min

10 (10, 10)

0.001*

0.003^#

0.038^#

UA pH

7.34 ± 0.06

7.34 ± 0.08

7.32 ± 0.09

0.021

0.759

0.014

UA base excess

-1.0 ± 2.6

-1.3 ± 2.9

-2.0 ± 3.6

0.004

0.124

0.010

Epidural use (N)

50 (2.7%)

17 (2.8%)

2 (1.9%)

> 0.999**

> 0.999^##

**Table 3.** Mode of Delivery and Induction/Augmentation of Labor With or Without Nuchal Cord
Nulliparas	No NC (N = 1,619)	Single NC (N = 559)	Multiple NC (N = 99)	P-value
Cesarean section	57 (3.5%)	14 (2.5%)	0 (0%)
Vacuum extraction	169 (10.4%)	53 (9.5%)	19 (19.2%)	0.016	> 0.999	0.016
Normal delivery	1,393 (86.0%)	492 (88.0%)	80 (80.8%)
Induction/augmentation	538 (33.2%)	186 (33.3%)	36 (36.4%)	0.806	> 0.999	> 0.999
NC: nuchal cord. P-value: Fisher’s exact test (for all), Fisher’s exact test with Bonferroni correction (no NC vs. single or multiple NC).
Cesarean section	1 (0.1%)	0 (0%)	0 (0%)
Vacuum extraction	28 (1.5%)	17 (2.8%)	4 (3.8%)	0.096	0.297	0.416
Normal delivery	1,799 (98.4%)	599 (97.2%)	100 (96.2%)
Induction/augmentation	306 (16.7%)	107 (17.4%)	20 (19.2%)	0.733	> 0.999	> 0.999

Table 3. Mode of Delivery and Induction/Augmentation of Labor With or Without Nuchal Cord

Nulliparas

No NC (N = 1,619)

Single NC (N = 559)

Multiple NC (N = 99)

P-value

For all

No NC vs. single NC

No NC vs. multiple NC

Cesarean section

57 (3.5%)

14 (2.5%)

0 (0%)

Vacuum extraction

169 (10.4%)

53 (9.5%)

19 (19.2%)

0.016

> 0.999

0.016

Normal delivery

1,393 (86.0%)

492 (88.0%)

80 (80.8%)

Induction/augmentation

538 (33.2%)

186 (33.3%)

36 (36.4%)

0.806

> 0.999

Multiparas

No NC (N = 1,828)

Single NC (N = 616)

Multiple NC (N = 104)

P-value

For all

No NC vs. single NC

No NC vs. multiple NC

NC: nuchal cord. P-value: Fisher’s exact test (for all), Fisher’s exact test with Bonferroni correction (no NC vs. single or multiple NC).

Cesarean section

1 (0.1%)

0 (0%)

Vacuum extraction

28 (1.5%)

17 (2.8%)

4 (3.8%)

0.096

0.297

0.416

Normal delivery

1,799 (98.4%)

599 (97.2%)

100 (96.2%)

Induction/augmentation

306 (16.7%)

107 (17.4%)

20 (19.2%)

0.733

> 0.999

**Table 4.** Duration of the First and Second Stage of Labor With or Without Nuchal Cord
Nulliparas	No NC (N = 1,561)	Single NC (N = 545)	Multiple NC (N = 99)	P-value
First stage of labor	558 (215, 1,478)	635 (222, 1,404)	550 (250, 1,490)	0.211	0.250	> 0.999
Second stage of labor	55 (19, 193)	59 (22, 194)	60 (18, 182)	0.183	0.198	> 0.999
NC: nuchal cord. Data: median (10th percentile, 90th percentile) (min). P-value: Kruskal- Wallis test (for all), Mann Whitney U test with Bonferroni correction (no NC vs. single or multiple NC).
First stage of labor	260 (104, 593)	270 (109, 592)	256 (90, 548)	0.313	0.631	> 0.999
Second stage of labor	13 (4, 39)	13 (4, 37)	12 (5, 39)	0.616	> 0.999	> 0.999

Table 4. Duration of the First and Second Stage of Labor With or Without Nuchal Cord

Nulliparas

No NC (N = 1,561)

Single NC (N = 545)

Multiple NC (N = 99)

P-value

For all

No NC vs. single NC

No NC vs. multiple NC

First stage of labor

558 (215, 1,478)

635 (222, 1,404)

550 (250, 1,490)

0.211

0.250

> 0.999

Second stage of labor

55 (19, 193)

59 (22, 194)

60 (18, 182)

0.183

0.198

> 0.999

Multiparas

No NC (N = 1,826)

Single NC (N = 616)

Multiple NC (N = 104)

P-value

For all

No NC vs. single NC

No NC vs. multiple NC

NC: nuchal cord. Data: median (10th percentile, 90th percentile) (min). P-value: Kruskal- Wallis test (for all), Mann Whitney U test with Bonferroni correction (no NC vs. single or multiple NC).

First stage of labor

260 (104, 593)

270 (109, 592)

256 (90, 548)

0.313

0.631

> 0.999

Second stage of labor

13 (4, 39)

13 (4, 37)

12 (5, 39)

0.616

> 0.999

**Table 5.** Rate of Prolonged Labor With or Without Nuchal Cord
Nulliparas	No NC (N = 1,562)	Single NC (N = 545)	Multiple NC (N = 99)	P-value
Prolonged first SoL^a (+)	251 (16.1%)	84 (15.4%)	14 (14.1%)	0.874	> 0.999	> 0.999
(-)	1,311	461	85
Prolonged second SoL^b (+)	163 (10.4%)	56 (10.3%)	9 (9.1%)	0.966	> 0.999	> 0.999
(-)	1,399	489	90
NC: nuchal cord; SoL: stage of labor. ^aDuration > 20 h. ^bDuration > 3 h, with epidural use > 4 h. ^cDuration > 14 h. ^dDuration > 2 h, with epidural use > 3 h. P-value: Fisher’s exact test (for all), Fisher’s exact test with Bonferroni correction (no NC vs. single or multiple NC).
Prolonged first SoL^c (+)	55 (3.0%)	18 (2.9%)	2 (1.9%)	0.926	> 0.999	> 0.999
(-)	1,772	598	102
Prolonged second SoL^d (+)	17 (0.9%)	4 (0.6%)	3 (2.9%)	0.096	> 0.999	0.267
(-)	1,810	612	101

Table 5. Rate of Prolonged Labor With or Without Nuchal Cord

Nulliparas

No NC (N = 1,562)

Single NC (N = 545)

Multiple NC (N = 99)

P-value

For all

No NC vs. single NC

No NC vs. multiple NC

Prolonged first SoL^a (+)

251 (16.1%)

84 (15.4%)

14 (14.1%)

0.874

> 0.999

(-)

1,311

461

Prolonged second SoL^b (+)

163 (10.4%)

56 (10.3%)

9 (9.1%)

0.966

> 0.999

(-)

1,399

489

Multiparas

No NC (N = 1,827)

Single NC (N = 616)

Multiple NC (N = 104)

P-value

For all

No NC vs. single NC

No NC vs. multiple NC

NC: nuchal cord; SoL: stage of labor. ^aDuration > 20 h. ^bDuration > 3 h, with epidural use > 4 h. ^cDuration > 14 h. ^dDuration > 2 h, with epidural use > 3 h. P-value: Fisher’s exact test (for all), Fisher’s exact test with Bonferroni correction (no NC vs. single or multiple NC).

Prolonged first SoL^c (+)

55 (3.0%)

18 (2.9%)

2 (1.9%)

0.926

> 0.999

(-)

1,772

598

102

Prolonged second SoL^d (+)

17 (0.9%)

4 (0.6%)

3 (2.9%)

0.096

> 0.999

0.267

(-)

1,810

612

101