Re: nuchal cords, etc
From: Moot (moot@mediaone.net)
Thu Jan 10 21:50:58 2002
Attached is image from 38/40 wk gest. Indication: confirm vtx presentation.
Midwife patient. Will give outcome if anyone interested.
Mary C. Scarboro
-----Original Message-----
From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net]On Behalf Of Daniel
Margulies
Sent: Thursday, January 10, 2002 11:23 PM
To: Multiple recipients of list ULTRASOUND
Subject: Re: nuchal cords, etc
Ok
let`s imagine you tell nothing of nuchal cords
Would you exclude a double or triple nuchal cord at term???
I do inform complex nuchal cords
Dani
>----- Original Message -----
From: Philippe Jeanty <jeanty@TheFetus.net>
To: Multiple recipients of list ULTRASOUND
<ultrasound@mail.medispecialty.com>
Sent: Thursday, January 10, 2002 12:10 PM
Subject: Re: nuchal cords, etc
> 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
>
