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Re: nuchal cords, etcFrom: Philippe Jeanty (jeanty@TheFetus.net)Thu Jan 10 08:08:37 2002
I think it really depends on how reassuring you are when you talk to the patient. First I tell them that both of my kids had nuchal cord, second we use the analogy of the guy that would want to hang by jumping from a chair.. but in the uterus there is no place to jump from... my patients do not seemed to be the least bit freaked out to know. I think that in the past 5 yrears we probably did not do 3 rescan for mom reassurance for nuchal cord. -----Original Message----- From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net]On Behalf Of art fougner, md Sent: Thursday, January 10, 2002 9:01 AM To: Multiple recipients of list ULTRASOUND Subject: nuchal cords, etc to look or not to look ahhh there's the rub. my personal BIAS is that i seldom ask a question if i don't know what to do with the answer. i get asked about nuchal cords on a regular basis - my least fave is at 20 wk scan. the earliest i have seen nuchal cord is at 15 wks. i certainly would not be terribly keen on reporting this finding, let alone telling the patient. in my neighborhood, telling the mom that there is a cord around the baby's neck is like asking her to live under the sword of damocles. these are situations akin to Roy Filly's "scary ultrasounds." what you end up doing is turning this woman's happy pregnancy into a nightmare existence. as for predictive value of ultrasound diagnosed nuchal cord - this is unclear and thus unproven. additionally, since nuchal cord is found in 20% of all deliveries, the significance of this finding remains to be demonstrated. truthfully, many antepartum fetal demises written off as "cord accidents" would probably be best left unexplained. i think that the nuchal cord is simply one of Louie's "usual suspects" from Casablanca. i do recall Dick Berkowitz advising me some time ago that he would never look for a nuchal cord and if seen would not report it - the ol clintonian "don't ask, don't tell." prolly the only subgroups with nuchal cord we do need to know about are the breeches about to undergo external version and those fetuses whose movements have markedly decreased. a tough situation to be sure and i thank god when i can answer the patient in the negative. i truly don't think there is a right answer but there can be many wrong answers. just my opinion - i could be wrong. art
-- art fougner, md ich bin ein New Yorker
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