Journal of the Society for Gynecologic Investigation

 

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Journal of the Society for Gynecologic Investigation, Vol. 10, No. 7, 406-411 (2003)
DOI: 10.1016/S1071-55760300139-4

The Effect of Nuchal Cord on Amniotic Fluid and Cord Blood Erythropoietin at Delivery

Kazumasa Hashimoto, MD

Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan; Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodocho, Izumi, Osaka 594-1101, Japan khashi{at}mch.pref.osaka.jp

James F. Clapp, MD

Department of Reproductive Biology, Case Western Reserve University at Metro Health Medical Center, Cleveland, Ohio; Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan

Objective: We investigated the effect of a nuchal cord on fetal hypoxia by using amniotic fluid and cord blood erythropoietin as markers of chronic and acute hypoxia, respectively.

Methods: A total of 167 full-term pregnancies without maternal complications or fetal prelabor complications except fetal growth restriction of unknown cause were studied prospectively. Of these, 47 had a nuchal cord at delivery, and 62 had one or more complications during labor and delivery (nonreassuring fetal heart rate pattern, birth weight less than 2500 g, Apgar score at 1 minute less than 7, presence of meconium-stained amniotic fluid, oligohydramnios), and 26 had both muchal cord and at least one of the intrapartum complications.

Results: Erythropoietin levels (mean ± standard error of the mean) were not significantly different between the nuchal cord group (n = 47) and the no nuchal cord group (n = 120) in either amniotic fluid (19.3 ± 4.1 mU/mL versus 13.7 ± 1.1 mU/mL) or cord blood (57.9 ± 10.3 mU/mL versus 52.1 ± 4.9 mU/mL). Similarly, in the 62 fetuses with intrapartum complications, there were no significant differences in amniotic fluid (14.3 ± 2.0 mU/mL versus 18.8 ± 2.9 mU/mL) or cord blood erythropoietin (66.9 ± 16.8 mU/mL versus 72.6 ± 12.6 mU/mL) levels between those with (n = 26) or without a nuchal cord (n = 36). Among the 107 uncomplicated cases, however, amniotic fluid erythropoietin was significantly elevated in the nuchal cord group (25.5 ± 8.7 mU/mL, n = 21) compared with what in the no nuchal cord group (11.5 ± 0.9 mU/mL, n = 84) (P < .05), whereas there was no significant between-group difference in cord blood erythropoietin levels between nuchal cord and no nuchal cord groups (46.8 ± 10.0 mU/mL versus 43.3 ± 4.1 mU/mL). Tightness of the nuchal cord did not affect amniotic fluid or cord blood erythropoietin concentrations.

Conclusion: Although nuchal cord may not significantly increase the risk of acute or labor-associated fetal hypoxia, it appears to be an independent risk factor of mild, chronic, prelabor fetal hypoxia.

Key Words: Erythropoietin • nuchal cord • amniotic fluid • cord blood


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