Re: Nuchal Cord Redux
From: Prof. Yaron Zalel (zalel_y@netvision.net.il)
Thu Dec 30 08:45:43 2004
I perfectly agree with Philipe - I mean to the 100% detection rate in
general and in particularily with nuchal cord detection rate. We are doing
it and studying it and the detection rate is NOT 100%!
Yaron Zalel
>----- Original Message -----
From: "Philippe Jeanty, MD, PhD" <jeanty@TheFetus.net>
To: "Multiple recipients of list ULTRASOUND" <ultrasound@dns.obgyn.net>
Sent: Thursday, December 30, 2004 5:20 PM
Subject: Re: Nuchal Cord Redux
> When I review articles and see 100% I get immediately suspicious. I have a
> long history of collecting errors and I do not believe in any 100% in
> Medicine. I know several of the authors and they are conscientious people.
I
> would suspect that detection can be very high but I am quite doubtful of
any
> 100%.
>
> Philippe Jeanty
>
> -----Original Message-----
> From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
Mario
> Libardi
> Sent: Thursday, December 30, 2004 2:57 AM
> To: Multiple recipients of list ULTRASOUND
> Subject: Re: Nuchal Cord Redux
>
> I agree 100% with Dr.Fazeel.
>
> Congrats
> Mario Libardi, MD
> Brasil
>
> > nuchal cord (presence or absence) detection rate should be
> 100% in good
> > hands and good machines with doppler.
> >
> > fazeel
> >
> > -------Original Message-------
> >
> > From: art fougner, mdDate: 12/29/04 18:19:12
> > To: Multiple recipients of list ULTRASOUND
> > Subject: Nuchal Cord Redux
> >
> > >From the White Journal Early View ( pre-release)...
> >
> > Ultrasound detection of nuchal cord prior to labor
> induction and the
> > risk of Cesarean section
> > E. Peregrine, P. O'Brien, E. Jauniaux
> > Department of Obstetrics and Gynaecology, University
> College London
> > Hospitals, London, UK
> >
> > Abstract
> >
> > Objectives
> > To investigate the ability of ultrasound to detect the
> presence of a
> > nuchal cord immediately prior to induction of labor and the
> association
> > of its presence with delivery by Cesarean section.
> >
> > Methods
> > A transabdominal ultrasound scan using gray-scale and color
> Doppler
> > imaging was performed immediately prior to induction of
> labor in 289
> > women in a prospective study to assess the presence of a
> nuchal cord.
> > The presence of a nuchal cord was classified as present,
> absent or
> > uncertain. The outcomes of labor, delivery and the neonates
> were
> > obtained from the patient notes after delivery.
> >
> > Results
> > A nuchal cord was present at 18% of deliveries. The
> incidence was not
> > affected by parity, fetal position or reduced amniotic
> fluid volume. The
> > sensitivity of ultrasound in diagnosing a nuchal cord was
> 37.5%, with
> > specificity, positive and negative predictive values of
> 80%, 29% and
> > 85%, respectively. The presence of a nuchal cord did not
> significantly
> > increase the risk of delivery by Cesarean section (35% vs.
> 28%;
> > relative risk = 1.22; 95% CI, 0.80-1.87), instrumental
> delivery for
> > fetal distress, an abnormal cardiotocograph in labor or at
> delivery, an
> > Apgar score < 7 at 1 min, arterial cord pH < 7.1 or
> neonatal unit
> > admission.
> >
> > Conclusions
> > The sensitivity of the ultrasound diagnosis of a nuchal
> cord is low
> > prior to induction of labor at term. A nuchal cord does not
> appear to
> > increase the risk of Cesarean section or of poor neonatal
> outcome. The
> > low ultrasound detection rate of a nuchal cord limits its
> use in
> > decision making prior to induction of labor in high-risk
> pregnancies.
> > Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
> >
> > art
> >
> > --
> > art fougner, md
> > May the Joy of this Holiday Season Be with You
> > and Yours throughout the New Year.
> >
>
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