Re: Double nuchal cord on ultrasound
From: Charlie Chambers (cchamber@gorge.net)
Wed Jun 9 16:27:40 2004
Brings up the argument of why report or look for the nuchal cord. I do
not routinely look for a nuchal cord, and doubt that I would report the
finding. After all, no tried and true management will impact outcome.
Plus, you are looking at up to 25% population will have a nuchal cord,
and will no sequelae.
************************************************************************
******
Charlie Chambers
Hood River, OR USA
cchamber@alumni.rice.edu
"All good things...come by grace,
and grace comes by art,
and art does not come easy."
Norman Maclean
************************************************************************
*******
On Jun 9, 2004, at 12:25 PM, Richard Chudacoff, MD wrote:
> I agree. I was always taught; if it doesn’t affect the outcome, don’t
> do the test. Here the test (ultrasound with noted nuchal cord) does
> not affect the management, unless you look at it from a purely
> medico-legal perspective, which we all are being forced to do by
> attorneys. I’m sure that someone, somewhere, would be willing to
> testify that the patient should have been offered alternative once the
> nuchal cord is discovered, or even immediate c-section once fetal lung
> maturity could be assured. So be it; I offer alternatives. It is all
> about practicing the best medicine I can, while getting sued the least
> I can. Lawsuits and the threat of lawsuits take their toll on solo
> practitioner the hardest; therefore they are ALWAYS at the forefront
> of my decisions made regarding these outside-of-the-textbook
> situations.
>
>
>
> Richard Chudacoff, MD
>
>
>
> Beer is living proof that God loves us and wants us to be happy.
>
> Benjamin Franklin
>
>
>
> Heaven grant that the burden you carry may have as easy an exit as it
> had an entrance.
>
> [Prayer To A Pregnant Woman]
>
> -Desiderius Erasmus
>
>
>
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> Braun, R. Daniel
> Sent: Wednesday, June 09, 2004 2:03 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: RE: Double nuchal cord on ultrasound
>
>
>
> All that will tell you is that the baby is alive. There will not be a
> decrease in fetal movement before you get an occlusion of the cord.
> Which by the way I think is either an act of G_d or FETUS.
>
>
>
> Dan
>
>
>
>
>
> "Sound is like water. If you drill one hole in the wall the sound will
> leak right through."
>
> - JAY BRAUN, a band member by love, a soundproofer by necessity.
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> Richard Chudacoff, MD
> Sent: Wednesday, June 09, 2004 12:42 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: RE: Double nuchal cord on ultrasound
>
> I think the studies regarding daily fetal movement assessment should
> be adequate. In my opinion, this is theoretical, since I specially
> will not look for nuchal cords for this very reason. I think it is a
> non-issue, brought up only when an ultrasound has been performed at an
> outside entity, such as a non-medical ultrasound center.
>
>
>
> Richard Chudacoff, MD
>
>
>
> Beer is living proof that God loves us and wants us to be happy.
>
> Benjamin Franklin
>
>
>
> Heaven grant that the burden you carry may have as easy an exit as it
> had an entrance.
>
> [Prayer To A Pregnant Woman]
>
> -Desiderius Erasmus
>
>
>
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> Braun, R. Daniel
> Sent: Wednesday, June 09, 2004 12:21 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: RE: Double nuchal cord on ultrasound
>
>
>
> If you are going to do ANYthing about it, you should undertake
> continuos fetal monitoring from the time of discovery until delivery.
> Anything else in either irrational or ineffective.
>
>
>
> Dan
>
>
>
>
>
> "Sound is like water. If you drill one hole in the wall the sound will
> leak right through."
>
> - JAY BRAUN, a band member by love, a soundproofer by necessity.
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> Richard Chudacoff, MD
> Sent: Wednesday, June 09, 2004 11:55 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: RE: Double nuchal cord on ultrasound
>
> You are right. Probably at 39 weeks, or sooner if indicated (labor,
> fetal distress, oligohydramnios)
>
>
>
> Richard Chudacoff, MD
>
>
>
> Beer is living proof that God loves us and wants us to be happy.
>
> Benjamin Franklin
>
>
>
> Heaven grant that the burden you carry may have as easy an exit as it
> had an entrance.
>
> [Prayer To A Pregnant Woman]
>
> -Desiderius Erasmus
>
>
>
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> ainsron
> Sent: Tuesday, June 08, 2004 7:32 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: RE: Double nuchal cord on ultrasound
>
>
>
> But at what point are you going to do the C/S? And during the
> intervening weeks, how are you going to monitor the fetus? What if
> the nuchal cord was found at 28 weeks? Its just such a nebulous bag
> of worms with no EBM to base any strict decision making on.
>
>
>
> Ronald E. Ainsworth
>
>
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> Richard Chudacoff, MD
> Sent: Tuesday, June 08, 2004 3:19 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: RE: Double nuchal cord on ultrasound
>
>
>
> So, you can debate with the patient for two weeks, with serious
> counseling about the benefit of a vaginal delivery, or you can say “if
> you are really worried we can perform a c-section; however we also
> have the option of close monitoring with fetal kick counts and
> continuous electronic fetal monitoring in labor.” Now the patient
> feels better, and if they chose the latter, at least they know you
> gave the finding a serious consideration, and the patient a choice of
> treatment options. If they chose the former, no IUFD. I’m fine with
> either, and probably have decreased my lawsuit potential dramatically.
>
>
>
> Richard Chudacoff, MD
>
>
>
> Beer is living proof that God loves us and wants us to be happy.
>
> Benjamin Franklin
>
>
>
> Heaven grant that the burden you carry may have as easy an exit as it
> had an entrance.
>
> [Prayer To A Pregnant Woman]
>
> -Desiderius Erasmus
>
>
>
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> DoctorJoe@aol.com
> Sent: Tuesday, June 08, 2004 4:43 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Double nuchal cord on ultrasound
>
>
>
> In a message dated 6/8/04 16:21:05, dellview@earthlink.net writes:
>
> We just had a double nuchal cord that was fine in the office on
> ultrasound
> last Wednesday and by Friday (when she came in with srom) the baby
> was a
> demise. my answer today is different than it was last week. it was a
> rough
> weekend
>
> And therein lies the problem. It's not a problem until something
> happens. And with cord problems, where the BABY governs what goes on
> in there, YOU have no control over what happens, except WHEN the baby
> comes out (i.e. when you make the incision). Other than that, you're
> merely an observer. (Not like severe preeclampsia, or whatever, where
> you can give medicine, etc.)
>
> Joe P.
