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Re: nuchal cords, etc From: Moot (moot@mediaone.net) Fri Jan 11 14:49:07 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DuBose, Terry: "Re: nuchal cords, etc" Previous message: DuBose, Terry: "Re: nuchal cords, etc" In reply to: DuBose, Terry: "Re: nuchal cords, etc" Next in thread: James S Smeltzer MD: "Re: nuchal cords, etc" Reply: James S Smeltzer MD: "Re: nuchal cords, etc" Okay, sorry I had meant to get back earlier today. This scan was performed about 9AM. Immediate assessment for fetal well being rendered a perfect 10/10. Pelvic revealed a sweetly inducible picture 3cm /+1 / 75-80% effaced. Mother multiparous G2, P1,L1- NVD. Midwife and mom elected to induce without heroics. Well mom induced, cord(s) reduced, vaginal delivery without complications by mid-afternoon. CAN x 3 confirmed at delivery. If mom asks about cord around neck I answer honestly, however I go on to quote statistics from article (I have to find it) that give a 25% rate of nuchal cord at time of delivery. The article also mentions that nuchal cord x 1 seems to present no added risk to the fetus. I also explain that the risk is cord compression not strangulation. I do not believe this little speech has failed to reassure mom. I do have a secret code for the report (3rd. trimesters or pre-versions) that is intended to enlighten the delivering provider if >2 wraps or if cord appears unusually taught. Mary C. Scarboro -----Original Message----- From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net]On Behalf Of DuBose, Terry Sent: Friday, January 11, 2002 2:51 PM To: Multiple recipients of list ULTRASOUND( Subject: Re: nuchal cords, etc If we can get a bit more text on this outcome, it would be a good item for the Gallery. Peace, Terry J. DuBose, M.S., RDMS Assistant Professor & Director, Diagnostic Medical Sonography Program CHRP, University of Arkansas for Medical Sciences Little Rock, Arkansas, USA 501-686-6510 http://www.io.com/~dubose/ http://www.uams.edu/CHRP/dmshome.htm http://www.obgyn.net/us/panel/panel.htm -----Original Message----- From: Moot [mailto:moot@mediaone.net] Sent: Thursday, January 10, 2002 10:53 PM To: Multiple recipients of list ULTRASOUND Subject: Re: nuchal cords, etc 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 > Next message: DuBose, Terry: "Re: nuchal cords, etc" Previous message: DuBose, Terry: "Re: nuchal cords, etc" In reply to: DuBose, Terry: "Re: nuchal cords, etc" Next in thread: James S Smeltzer MD: "Re: nuchal cords, etc" Reply: James S Smeltzer MD: "Re: nuchal cords, etc"

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