Re: Nuchal Cord Redux
From: art fougner, md (evsono@pipeline.com)
Thu Dec 30 08:49:54 2004
be careful about statements of 100% accuracy - thus far, i've never come
across a medical test with a 100% predictive value - including the
diagnosis of death. we still argue about the JFK autopsy. also, if you
check out the authors' cv's, they do seem to be "good people", doubtless
using "good equipment".
Happy 2005
art
At Thu, 30 Dec 2004, Mario Libardi wrote:
>
>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.
>>
>
--
art fougner, md
May the Joy of this Holiday Season Be with You
and Yours throughout the New Year.
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