PubMed · 14097781
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M SUZUMURA, T MITSUI, S KIKUCHI, M SAJI, S ICHIHASHI. 1963. [ON THE PARTOGRAM].. https://pubmed.ncbi.nlm.nih.gov/14097781/
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OBJECTIVES: To evaluate the clinical relevance of nuchal cord in normal, vertex, singleton pregnancies at term, and its effect on mode of delivery and perinatal outcome. STUDY DESIGN: Prospective study with 352 normal, singleton pregnancies, with fetuses in the vertex presentation, examined with real-time ultrasound at 37-39 weeks. Health care workers at labour and delivery blinded to previous detection of nuchal cord. RESULTS: Fetuses of nulliparous women with a nuchal cord were more likely to be delivered with operative vaginal or caesarean delivery (n = 153, p < 0.0001). This was not the case with higher parity (n = 199, p = 0.07). There was no difference between nuchal cord (n = 144) and control groups (n = 208) in amniotic fluid quantity at 37-39 weeks (p = 0.554) or intrapartum CTG (p = 0.9). On the other hand, nuchal cord group had lower Apgar scores at 1 and 5 min (p = 0.001 and 0.027 respectively); this difference remained significant when adjusted for birth weight (p = 0.001 and 0.016), but disappeared when adjusted for mode of delivery (p = 0.048 and 0.319). CONCLUSIONS: Nuchal cord in normal pregnancies at term is associated with increased rate of operative vaginal and caesarean delivery in nulliparae. The presence of a nuchal cord results in slightly lower Apgar scores at 1 and 5 min, mainly as a consequence of higher operative delivery rates.
In the UK a woman has the right to decide to give birth at home, irrespective of whether she is expecting her first or a subsequent child and of any perceived 'risk' factors. However, the rate of home births in the UK is very low (around 2%), varies widely across the country and many women do not know how to arrange midwifery cover. The Home Birth helpline is a UK-based voluntary organisation offering support and information for women planning a home birth. In order to gain direct access to the issues that are of concern to women when planning a home birth, 80 calls to the helpline were recorded. The aims of this paper are to document the problems that callers to this helpline report having when trying to arrange home births and to explore the strategies the call-taker uses in helping women to exercise their right to birth at home. The paper concludes that women are not easily able to exercise their right to choose the place of birth and suggests a number of recommendations for action.