Two-Dimensional Ultrasonography in the Assessment of Nuchal Cord

The aim of this was to evaluate the accuracy of two-dimensional (2D) ultrasonography in the diagnosis of nuchal cord to enable us determine if it can be recommended for its antenatal diagnosis. Between 01 January and 30 April 2012, 93 singletons pregnancies in cephalic presentation with 2D ultrasound scan done at term but within 24 h before onset of labor for exploration of the presence or absence of nuchal cord were reviewed. The procedure was carried out using the same equipment (Voluson 730 Expert) and by the same radiologist who had good training in the ultrasonographic diagnosis of nuchal cord. Among the 38 cases of nuchal cord present at delivery, the diagnosis by means of 2D ultrasonography was done in 32 cases (sensitivity: 84.2 %). The diagnosis was also correct among 47 of the 55 absent nuchal cords at delivery (specificity: 85.4 %). In eight cases, nuchal cord diagnosed by 2D ultrasonography was not observed at delivery (positive predictive value: 80 %). Furthermore, six cases of nuchal cord were undiagnosed by 2D ultrasonography (negative predictive value: 88.7 %). Two-dimensional ultrasonography for the antenatal diagnosis of nuchal cord by a skilled radiologist can reach sensitivity and specificity of more than 84 %. Therefore, in settings where only 2D ultrasonography is available, efforts should be made by operators for antenatal diagnosis of nuchal cord.