From: Philippe Jeanty, MD, PhDDate: 12/30/04 14:17:33
To: Multiple recipients of list ULTRASOUND
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
>mailto:ultrasound@obgyn.net">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.
>
