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From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Allen
Worrall
Sent: Tuesday, 24 February 2004 12:03 PM
To: Multiple recipients of list ULTRASOUND
Subject: Re: ULTRASOUND digest 2170 Nuchal Cord
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
HYPERLINK "mailto:jworrall@alaska.net"jworrall@alaska.net
HYPERLINK "http://www.obgynsono.com"www.obgynsono.com
>----- Original Message -----
From: HYPERLINK "mailto:jeanty@TheFetus.net"Philippe Jeanty
To: HYPERLINK "mailto:ultrasound@dns.obgyn.net"Multiple recipients of list
ULTRASOUND
Sent: Monday, February 23, 2004 4:26 PM
Subject: Re: ULTRASOUND digest 2170 Nuchal Cord
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: HYPERLINK "mailto:ultrasound@obgyn.net"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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