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Re: Nuchal CordFrom: Philippe Jeanty, MD, PhD (jeanty@TheFetus.net)Thu Feb 19 09:09:07 2004
Yes of course.. these are clear cut cases (Cheryl Turner, one of my beloved sonographer, published a case of 5 loops (some images are in http://www.TheFetus.net > Articles> Cord > review) and that kiddo was c-sectioned quite rapidly). I believe that the unnecessary angst is for the fetuses with single loop ! Those need to be reassured (I have some MD emailing me that some patient pressured them into making C-section for the finding!). Again, as for the minor markers of aneuploidy, how you communicate to the patient is crucial. The issue of communication to the patient is covered in the lecture on pitfalls and artifact (http://www.thefetus.net/product.php?id=1209) Thus, I clearly agree with you and the communication to the patient should be adapted to the findings of the examination. Sometimes even a single loop of cord should be a reason to prompt for intervention. We had a fetus with a single loop placed such as it was very tight (resistive Doppler signal in the cord leading from the placenta to the neck) with growth restriction and with further stricture as the fetus was trying to stretch. This is an old case and the details are a little fuzzy in my memory but if I recall properly that baby was given corticoids and delivered prematurely. So no-cookie cutter approach ! -----Original Message----- From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Ilvlucy@aol.com Sent: Thursday, February 19, 2004 9:25 AM To: Multiple recipients of list ULTRASOUND Subject: Re: Nuchal Cord I TOTALLY AGREE THAT THE TRICK IS TO GIVE THE INFO SO THE PT DOESN'T FREAK OUT, BUT YOUR ANSWER CONFUSED ME. ARE YOU SAYING....THAT THE NUCHAL CORD SHOULD BE DOCUMENTED, AND THE PATIENT HAS THE RIGHT TO KNOW. I'M NOT SURE I AGREE WITH THE MANAGEMENT BEING THE SAME. IF ONE SEES A VERY TIGHT NUCHAL CORD X3 AROUND THE NEXT, WOULDN'T THAT BE AN INDICATION FOR REPEATING THE SCAN AT A LATER DATE, OR AT LEAST MONITORING THE PT?
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