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Re: ULTRASOUND digest 2170 Nuchal CordFrom: Allen Worrall (jworrall@alaska.net)Mon Feb 23 19:01:43 2004
And cords around the neck do sometimes cause serious problems at delivery, particularly when the cord is short. Your reporting the cord may not save the baby, and your reporting the cord may put the monkey on the obstetrician's back, but it is the right thing to do, if you are sure the cord is around the neck and not just draped over the back of the neck and a little down the sides. I describe what I see. Most of the time I cannot say that the cord goes all around the neck, because I cannot see that with color flow (I have a Philips HDI 5000). Most of time the baby is spine up, I note the cord indenting the skin of the back of the neck, and I can trace the cord down the side of the neck on one side, maybe both sides, but cannot see the cord going around the front of the neck. I report just that. I may not talk to the patient about it, but I do put it in the report. If the patient notes that I am spending extra time tracing the cord, and asks me about it, I will tell them what I am doing and why. If the sonographer sees a nuchal cord (whatever type) and does not report it, does not image it, and does not make a video tape of the exam for him or her self or the patient, then the sonographer does not have to worry about it at all in the rare instance where there is a bad outcome due to nuchal cord. Most likely, even if they hear that this baby was stillborn or was very depressed at birth, they might not remember that their exam did show a nuchal cord. And even if they do remember that it did, they can say "no it did not" if they are asked, and there will not be any evidence. That does not sound like what most sonographers would want or do. So what we really are talking about is this: should we conceal a finding because it will cause the patient some anxiety, and most of the time is of no consequence? My answer is no, we should report what we see to the ob provider. This thread has already dealt with the question of the sonographer or sonologist reporting to the patient. Most of the time I do not, but sometimes I do, knowing full well that the monkey will surely now be on the ob's back. Joseph A Worrall MD RDMS The Fairbanks Clinic 1919 Lathrop Street, Suite 100 Fairbanks, AK 99701 jworrall@alaska.net http://www.obgynsono.com
> ----- Original Message ----- Well the standard of care varies from one region to another, but in the US not reporting a documented fact will get you in trouble. -----Original Message----- From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Prakie Persad Sent: Monday, February 23, 2004 7:22 PM To: Multiple recipients of list ULTRASOUND Subject: Re: ULTRASOUND digest 2170 Nuchal Cord I personally believe that we should not comment or document the nuchal cord even if it is observed. There is in fact no correlation between the presence of a nuchal cord and fetal outcome (The same cannot be said of a true cord knot, though). If this is brought into the picture and should the fetal outcome be less than optimal for any of many non-related issue, it raises the possibility of medico-legal action. In many centres, a large category of fetal demise remains "unexplained fetal death". The cord is around the fetal neck in almost 25% of all deliveries anyway. Prakashbhan Persad Consultant Obstetrician/ Perinatologist General Hospital, San Fernando Trinidad & Tobago
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