Impact of nuchal cord on fetal outcomes, mode of delivery, and management: a questionnaire survey of pregnant women

摘要

Objectives: To explore pregnant women’s views on the impact of nuchal cord on fetal outcomes, mode of delivery, and management. Design: Questionnaire survey. Setting: Antenatal clinic of two regional hospitals in Hong Kong. Participants: A questionnaire survey of all pregnant women at their first visit to the antenatal clinic of United Christian Hospital and Tseung Kwan O Hospital in Hong Kong was conducted between August and October 2012. Results: Most participants (71.8%) were worried about nuchal cord, and 78.3% and 87.7% of them thought that nuchal cord could cause intrauterine death and fetal death during labour, respectively. Approximately 87.5% of participants thought that nuchal cord would reduce the chance of successful vaginal delivery and 56.4% thought that it would increase the chance of assisted vaginal delivery. Most (94.1%) participants thought that it was necessary to have an ultrasound scan at term to detect nuchal cord. In addition, 68.8% thought that it was necessary to deliver the fetus early and 72.8% thought that caesarean section must be performed in the presence of nuchal cord. Participants born in Mainland China were significantly more worried about the presence of nuchal cord than those born in Hong Kong. However, there was no difference between participants with different levels of education. Conclusion: Most participants were worried about the presence of nuchal cord. Many thought that nuchal cord would lead to adverse fetal outcomes, affect the mode of delivery, and require special management. These misconceptions should be addressed and proper education of women is needed. New knowledge added by this study Most women were worried about the presence of nuchal cord. Many women thought that nuchal cord would lead to adverse fetal outcomes, affect the mode of delivery, and require special management. Implications for clinical practice or policy Avoiding routine ultrasound scans for nuchal cord in order to reduce needless maternal anxiety and unnecessary caesarean sections on women’s request is warranted. The correct concept that nuchal cord would not normally lead to adverse fetal outcomes and that its presence should not affect the mode of delivery should be publicised widely in Hong Kong. [in Chinese] Introduction In daily clinical practice, pregnant women regularly request antenatal ultrasound scans to look for nuchal cord around the time of delivery or request that the presence of nuchal cord is specifically checked for when they undergo ultrasound scans for other obstetric reasons. Many women have requested elective caesarean sections because nuchal cord has been detected on ultrasound scan. In order to explore women’s views on the impact of nuchal cord on fetal outcomes, mode of delivery and management, we conducted a questionnaire survey to evaluate their true concerns and beliefs. Methods A questionnaire evaluating the impact of nuchal cord on fetal outcomes and mode of delivery were distributed to all pregnant women at their first antenatal visit to the out-patient clinic of United Christian Hospital and Tseung Kwan O Hospital from August to October 2012. The questionnaire was in three versions: traditional Chinese, simplified Chinese, and English according to the participant’s preference ( Appendices 1 to 3 ). Participants who were not able to understand Chinese or English were excluded from the study. The questionnaires were collected by the nursing staff immediately after completion. Assuming that 50% of the women would express concern about the presence of nuchal cord, a sample size of 357 women would allow for random errors of up to 5%. Assuming the response rate to the questionnaire to be around 80%, distribution of around 450 questionnaires would be sufficient. The Statistical Package for the Social Sciences (Windows version 20.0; SPSS Inc, Chicago [IL], US) was used for statistical analysis. Chi squared test and Fisher’s exact test were used when appropriate. All the differences were defined as being statistically significant at PTable 1. Demographic data of the participants (n=869) Table 2. Comparison of the demographic data of participants who were concerned about nuchal cord The perceived incidence of nuchal cord was assessed by a linear scale from 0% to 100%. Excluding the 50 participants who did not reply to this question, 37.9% thought that the incidence of nuchal cord was less than 20%. The perceived sonographic accuracy for nuchal cord was similarly assessed. Around one third (31.2%) of participants thought that the accuracy was less than 70% while 35 participants did not answer this question. The perceived impact of nuchal cord on fetal outcomes, mode of delivery, and management are shown in Table 3 . Around 78.3% and 87.7% thought that nuchal cord could cause intrauterine death and fetal death during labour, respectively, while 87.5% of participants thought that it would reduce the chance of successful vaginal delivery and 56.4% thought that it would inc