Cordonal risk: perinatal e maternal outcomes
Methods. A retrospective study was carried out on a total of 3.186 pregnant women who gave birth at the U.O.C. Gynaecology and Obstetrics, University Hospital "Paolo Giaccone" over a period of three years from the 1st January, 2012 to the 31st December, 2015. The patients involved in the study were nulliparous and multiparous women at term of pregnancy with a single foetus in cephalic presentation, in spontaneous or induced labour, who were diagnosed with a funicular pathology at birth.
Results. Funicular anomalies were diagnosed in 280 women (8.7%), of whom 153 (55%) were nulliparous and 127 (45%) were multiparous. Nuchal cord was the most frequently observed anomaly with 233 cases (83.2%). In 270 cases (96,4%) the 1-minute Apgar score was ≥7, in 8 cases (2.8%) it was between 4 and 6, and in 2 cases (0.7%) it was lower than 4. In 279 cases (99.6%) the 5-minute Apgar score was >7 and only in one case (0.4%) it was between 4 and 6. In none of these cases was admission to the NICU necessary. In 182 cases (65%) there was no cardiotocographic alteration; in 63 cases (22%) saltatory heart rate patterns were recorded; in 33 cases (12%) variable decelerations were observed; in 2 cases (0.7%) bradycardia was detected. Spontaneous delivery was observed in 149 cases (53.2%), while a caesarean section was necessary in 131 cases (46.8%), of which 11 (8.4%) were referable to cardiotocographic abnormalities caused by the funicular pathology.
Conclusions. In our experience, the funicular pathology is rarely associated with adverse perinatal outcomes. That is why it should not influence the management of childbirth, as well as labour, and should be looked for only in the case of a non-reassuring CTG pattern.