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Re: Nuchal cordFrom: Allen Worrall (jworrall@alaska.net)Sun Jul 10 00:33:32 2005
Keeping in mind that medical liability issues are a major concern here in the US, here is the way I look at it. There is no doubt that the evidence indicates that the nuchal cord rarely causes problems. Because of that, many sonologists feel that it need not be reported because of the anxiety it causes in the patient and her obstetrical provider. In the third trimester I report nuchal cords. Although the nuchal cord rarely causes problems, sometimes it does cause a problem. I video tape my exams. If I see a nuchal cord in the third trimester (when it is more likely to be present when labor starts, compared to a 2nd trimester nuchal cord) and do not report it, and the nuchal cord does cause fetal anoxia, and the patient sues, and my video tape is obtained by the plaintiff attorney, and the nuchal cord is clearly seen, the obstetrician will point to me as the guilty party. The obstetrician's position will be that if she knew the nuchal cord was present, she would have had an ultrasound done at the onset of labor, and if the nuchal cord was still demonstrated, she would have done a C Section. So in effect, when I report a nuchal cord, I am putting the monkey on the obstetrician's back and taking the monkey off my back. I particularly report a nuchal cord in the third trimester in a breech presentation, or if the back of the fetal neck is near the transducer and I can clearly see that the cord is deeply indenting the skin of the back of the neck. Attempt at external version of breech is common here, and if there is nuchal cord, I doubt the obstetrician would attempt external version. Allen
> ----- Original Message ----- Dear friends, Is there a consensus on reporting of nuchal cord , esp. in the III Trimester ? We have a debate on this topic next week. Any help on this topic will be appreciated. Please give your inputs - personal experiences and view-points. Thanks, LN. Bangalore, India
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