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Nuchal Cord ReduxFrom: art fougner, md (evsono@pipeline.com)Wed Dec 29 12:07:29 2004
>From the White Journal Early View ( pre-release)... Ultrasound detection of nuchal cord prior to labor induction and the risk of Cesarean section E. Peregrine, P. O'Brien, E. Jauniaux Department of Obstetrics and Gynaecology, University College London Hospitals, London, UK Abstract Objectives To investigate the ability of ultrasound to detect the presence of a nuchal cord immediately prior to induction of labor and the association of its presence with delivery by Cesarean section. Methods A transabdominal ultrasound scan using gray-scale and color Doppler imaging was performed immediately prior to induction of labor in 289 women in a prospective study to assess the presence of a nuchal cord. The presence of a nuchal cord was classified as present, absent or uncertain. The outcomes of labor, delivery and the neonates were obtained from the patient notes after delivery. Results A nuchal cord was present at 18% of deliveries. The incidence was not affected by parity, fetal position or reduced amniotic fluid volume. The sensitivity of ultrasound in diagnosing a nuchal cord was 37.5%, with specificity, positive and negative predictive values of 80%, 29% and 85%, respectively. The presence of a nuchal cord did not significantly increase the risk of delivery by Cesarean section (35% vs. 28%; relative risk = 1.22; 95% CI, 0.80-1.87), instrumental delivery for fetal distress, an abnormal cardiotocograph in labor or at delivery, an Apgar score < 7 at 1 min, arterial cord pH < 7.1 or neonatal unit admission. Conclusions The sensitivity of the ultrasound diagnosis of a nuchal cord is low prior to induction of labor at term. A nuchal cord does not appear to increase the risk of Cesarean section or of poor neonatal outcome. The low ultrasound detection rate of a nuchal cord limits its use in decision making prior to induction of labor in high-risk pregnancies. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd. art
-- art fougner, md May the Joy of this Holiday Season Be with You and Yours throughout the New Year.
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