The Impact of Nuchal Cord on Fetal Outcome, Mode of Delivery, and Its Management: A Questionnaire Survey of All Hong Kong Obstetricians and Gynaecologists

Abstract

Objectives: To explore the view of Hong Kong obstetrics and gynaecology specialists on the impact of nuchal cord on fetal outcome, mode of delivery, and its management.
Methods: A questionnaire was mailed to all registered Hong Kong specialists in obstetrics and gynaecology (n=381) in July 2012 with a prepaid return envelope.
Results: The overall response rate was 50.7%. About one-third and one-fifth of specialists considered that
nuchal cord could cause intrauterine death and intrapartum fetal death / neonatal death, respectively. In addition, approximately half believed that it reduced the possibility of a successful normal vaginal delivery, and increased the rate of assisted vaginal delivery. Nonetheless only 4.7% would advise patients to elect for Caesarean section in the presence of nuchal cord. There were no significant differences in the opinions of the impact of nuchal cord on fetal outcome and mode of delivery between specialists working in the Hospital Authority / public institutions versus those in private practice, between Maternal-Fetal Medicine (MFM) subspecialists versus non-MFM specialists, as well as between specialists with different years of practice after obtaining Fellowship of the Hong Kong Academy of Medicine. Around one-third in private practice routinely screened for nuchal cord on ultrasound, compared with none who practised in Hospital Authority / public institutions.
Conclusion: A significant proportion of obstetrics and gynaecology specialists thought that nuchal cord would lead to adverse fetal outcome and affect the mode of delivery. A large local study of nuchal cord should be conducted in order to guide clinical management and provide evidence for patient counselling.