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Re: Nuchal cord From: James Smeltzer (James.Smeltzer@wellstar.org) Wed Oct 5 15:52:25 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Diane B Cressy: "AFI in Twin pregnancy" Previous message: James Smeltzer: "Re: Markers" ...problem is -- if you're also the obstetrician, you put the monkey on yourself, and let me tell you, my back's pretty crowded. I treat nuchal cords the same way as i treat incidental cardiac decelerations, isolated echogenic foci, and certain relatives -- I do my best to ignore them. Amen! Ultrasound detection of nuchal cord prior to labor induction and the risk of Cesarean section. Peregrine E, O'Brien P, Jauniaux E. Ultrasound Obstet Gynecol. 2005 Feb;25(2):160-4. Department of Obstetrics and Gynaecology, University College London Hospitals, London, UK. 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. Risk factors and outcomes associated with nuchal cord. A population-based study. Rhoades DA, Latza U, Mueller BA. J Reprod Med. 1999 Jan;44(1):39-45. Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, USA. rhoadesd@polarisz.uchsc.edu OBJECTIVE: To assess risk factors and outcomes associated with nuchal cord at birth. STUDY DESIGN: A population-based, case-control study was conducted using linked birth and hospitalization records. Three thousand newborns were randomly selected from all singleton births with nuchal cord as noted on the birth record (n = 5,426) in King County, Washington, 1992-1993. For comparison, 3,000 controls were randomly selected from the 46,952 unaffected singleton births. RESULTS: An increased risk of nuchal cord was associated with induction of labor (odds ratio [OR] adjusted for maternal age and parity 2.0, 95% confidence interval [CI] 1.7-2.3), African American infant race (OR 1.3, 95% CI 1.0-1.6), primiparity (OR 1.2, 95% CI 1.0-1.5) and male sex (OR 1.2, 95% CI 1.0-1.3). After exclusion of selected obstetric complications, the risk of nuchal cord associated with induction of labor increased (OR 2.4, 95% CI 2.0-3.0). Nuchal cord was associated with increased risks of fetal distress (OR 2.7, 95% CI 2.1-3.4), meconium staining (OR 2.1, 95% CI 1.7-2.6), five-minute Apgar score < 7 (OR 1.6, 95% CI 1.1-2.4) and assisted ventilation < 30 minutes (OR 1.9, 95% CI 1.4-2.6). Although hospital charges for newborns with nuchal cord were slightly greater than for those without (P = .02), hospital lengths of stay did not differ significantly. CONCLUSION: Induction of labor was identified as an independent risk factor for nuchal cord. Certain adverse perinatal outcomes are increased in neonates with nuchal cord. However, neonates with nuchal cord do not have significantly longer neonatal hospital stays, and thus the adverse effects of nuchal cord may be transient. Outcome of infants born with nuchal cords. Miser WF. J Fam Pract. 1992 Apr;34(4):441-5. Family Practice Service, Reynolds Army Community Hospital, Fort Sill, OK. BACKGROUND. The effect of a nuchal cord on the outcome of delivery is controversial. The purposes of this study were to investigate the frequency of nuchal cords and determine the effect that nuchal cords have on the neonate. METHODS. In a retrospective, case-control study, 706 consecutive infant deliveries in a community hospital were evaluated. Sixteen deliveries that were complicated by the umbilical cord entangled around an extremity or by a prolapsed cord were excluded from further analysis. The study group consisted of the 167 deliveries (23.7%) complicated by a nuchal cord. The remaining 523 deliveries were used as the control group. RESULTS. There were no significant differences found in maternal age, race, parity, prepregnancy weight, or amount of weight gain between the mothers of the infants in the two groups. Fetal bradycardia and variable decelerations in fetal heart rate occurred almost twice as often in the nuchal cord group (18.6% as compared with 9.6%, P less than .01). Despite this finding, there was no significant difference in the number of operative deliveries or in Apgar scores at 1 and 5 minutes between the two groups. There were no perinatal deaths associated with nuchal cords. Infants born with nuchal cords weighed less than those in the control group (3345 g compared with 3468 g, P less than .01). There were also significantly fewer large-for-gestational-age and macrosomic infants born in the nuchal cord group. Complications such as jaundice, hypoglycemia, sepsis, and respiratory problems were not increased in the postnatal period because of a nuchal cord. CONCLUSIONS. This study suggests that nuchal cords are common and are rarely associated with significant morbidity or mortality in neonates. I thought there was a recent article on the OTHER side... showing risk but I cannot find it! Help?! Jim Latha Natarajan <nattu@vsnl.com> wrote:Thanks Ibrahim. LN. >----- Original Message ----- From: bouthina ibrahim To: Multiple recipients of list ULTRASOUND Sent: Sunday, July 10, 2005 10:30 AM Subject: Re: Nuchal cord we must examine fetal nect in transverse view and examine number of knots around fetal neckas it may cause fetal iugr "art fougner, md" <evsono@pipeline.com> wrote: No consensus presently - this topic has been discussed before ... try the search function and you'll find many diverse opinions. art At Sat, 9 Jul 2005, Latha Natarajan wrote: > >--Boundary_(ID_Os0C21aoRU8/92gmFAjv/Q) >Content-type: text/plain; charset=iso-8859-1 >Content-transfer-encoding: 7BIT > >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 > >--Boundary_(ID_Os0C21aoRU8/92gmFAjv/Q) >Content-type: text/html; charset=iso-8859-1 >Content-transfer-encoding: 7BIT > > 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 > >--Boundary_(ID_Os0C21aoRU8/92gmFAjv/Q)-- -- art fougner, md "If you don't know where you are going, you will wind up somewhere else." Lawrence Peter Berra Tired of spam? Yahoo! Mail has the best spam protection around David J. Berck, MD, MPH >>>>>>>>>>>>> Confidentiality Disclaimer <<<<<<<<<<<<<<<< This email and any files transmitted with it may contain confidential and /or proprietary information in the possession of WellStar Health System, Inc. ("WellStar") and is intended only for the individual or entity to whom addressed. This email may contain information that is held to be privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient, you are hereby notified that any unauthorized access, dissemination, distribution or copying of any information from this email is strictly prohibited, and may subject you to criminal and/or civil liability. If you have received this email in error, please notify the sender by reply email and then delete this email and its attachments from your computer. Thank you. ================================================================ Next message: Diane B Cressy: "AFI in Twin pregnancy" Previous message: James Smeltzer: "Re: Markers"

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