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Zabit R, Tirosh D, Benshalom-Tirosh N, Baumfeld Y, Hershkovitz R, Baron J. Impact of cord entanglement on perinatal outcome. Eur J Obstet Gynecol Reprod Biol 2024; 299:163-166. [PMID: 38875852 DOI: 10.1016/j.ejogrb.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE To evaluate the impact of umbilical cord entanglement around various fetal organs on perinatal outcomes. STUDY DESIGN A retrospective population-based study of all deliveries between 1988 and 2016 at a tertiary medical center. Immediate perinatal outcomes of newborns with and without cord entanglement were compared. RESULTS The prevalence of any cord entanglement in our population was 16.62 % (45,312 cases out of 272,713 deliveries during the study period). Cord entanglement was found to be significantly associated with antepartum fetal death (OR = 2.13, 95 % CI 1.77-2.57, p < 0.001) and one-minute Apgar score less than 7 (OR = 1.21, 95 % CI 1.16-1.27, p < 0.001). There was no association between cord entanglement and small for gestational age (SGA) babies. CONCLUSION Cord entanglement is associated with antepartum fetal death, but not with SGA.
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Affiliation(s)
- Reem Zabit
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Rager Boulevard, PO Box 151, Beer-Sheva 84101, Israel.
| | - Dan Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Rager Boulevard, PO Box 151, Beer-Sheva 84101, Israel.
| | - Neta Benshalom-Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Rager Boulevard, PO Box 151, Beer-Sheva 84101, Israel.
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Rager Boulevard, PO Box 151, Beer-Sheva 84101, Israel.
| | - Ralika Hershkovitz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Rager Boulevard, PO Box 151, Beer-Sheva 84101, Israel.
| | - Joel Baron
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Rager Boulevard, PO Box 151, Beer-Sheva 84101, Israel.
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Beer N, Danieli-Gruber S, Bardin R, Berezowsky A, Hadar E, Arbib N. Adverse outcomes of nonnuchal umbilical cord entanglement. Int J Gynaecol Obstet 2024; 164:166-172. [PMID: 37485672 DOI: 10.1002/ijgo.14992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To evaluate perinatal effects of umbilical cord entanglement (UCE) of different body parts. METHODS The database of a tertiary medical center was retrospectively searched for women who gave birth to a liveborn singleton newborn in 2014-2018. Those diagnosed postpartum with UCE were matched 1:10 with women who were not and compared for adverse obstetric and neonatal outcomes, overall and by site of entanglement. RESULTS A total of 14 299 women were evaluated, of whom 1243 were diagnosed with UCE: 78.7% neck, 26% trunk, 6.7% limb. UCE was associated with lower birth weight percentile and higher rate of small for gestational age, but findings were significant only for neck and trunk UCE. On multivariate regression analysis adjusted for maternal age, parity, gestational age at birth, and history of cesarean delivery, UCE was an independent risk factor for nonreassuring fetal heart rate, labor induction, operative vaginal delivery, cesarean delivery, and meconium-stained amniotic fluid, but not for lower absolute birth weight/birth weight percentile, small for gestational age, low 1-min Apgar score, or neonatal asphyxia. CONCLUSION While fetuses with UCE might be more compromised during labor, they apparently recover shortly after birth. The impact on perinatal outcomes was similar for UCE of the neck and trunk and lower for UCE of the limb.
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Affiliation(s)
- Noam Beer
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
| | - Shir Danieli-Gruber
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Bardin
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexandra Berezowsky
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nissim Arbib
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
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Habek D, Mikuš M, Cerovac A. Cutting of the strangulated double nuchal umbilical cord in a release of the severe shoulder dystocia: forensically justified or controversial procedure. J Perinat Med 2023; 51:1239-1240. [PMID: 37309568 DOI: 10.1515/jpm-2023-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Dubravko Habek
- Department of Gynecology and Obstetrics Clinical Hospital Merkur Zagreb, School of Medicine, Catholic University of Croatia Zagreb, Croatian Academy of Medical Sciences Zagreb, Zagreb, Croatia
| | - Mislav Mikuš
- Department of Gynecology and Obstetrics, Clinical Hospital Zagreb, Zagreb, Croatia
| | - Anis Cerovac
- Department of Gynaecology and Obstetrics, General Hospital Tešanj, Tešanj, Bosnia and Herzegovina
- Department of Anatomy, School of Medicine, University of Tuzla, 75000 Tuzla, Bosnia and Herzegovina
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Is There an Added Neonatal Risk in Vacuum-Assisted Deliveries with Nuchal Cord? J Clin Med 2022; 11:jcm11236970. [PMID: 36498545 PMCID: PMC9739457 DOI: 10.3390/jcm11236970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
This retrospective cohort study assessed the association between nuchal cord and adverse outcomes during vacuum-assisted delivery (VAD). Women with singleton pregnancies, 34−41-weeks gestation, who underwent VAD, from 2014 to 2020 were included. The primary outcome was umbilical cord pH ≤ 7.1. Secondary outcomes were neonatal intensive care unit admission, Apgar scores, pH < 7.15, subgaleal hematoma, shoulder dystocia and third/fourth-degree perineal tear. Outcomes were compared between neonates with (1059/3754, 28.2%) or without (71.8%) nuchal cord after VAD. No difference in cord pH ≤ 7.1 was found between groups. The nuchal cord group had a lower rate of nulliparity (729 (68.8%) vs. 2004 (74.4%), p = 0.001) and higher maternal BMI (23.6 ± 4.3 vs. 23.1 ± 5, p = 0.017). Nuchal cord was associated with higher rates of induction (207 (19.5%) vs. 431 (16%), p = 0.009) and lower birthweights (3185 ± 413 vs. 3223 ± 436 g, p = 0.013). The main indication for VAD in 830 (80.7%) of the nuchal cord group was non-reassuring fetal heart rate (NRFHR) vs. 1989 (75.6%) controls (p = 0.004). The second stage was shorter in the nuchal cord group (128 ± 81 vs. 141 ± 80 min, p < 0.001). Multivariate regression found nulliparity, induction and birthweight as independent risk factors for nuchal cord VAD. Although induction and NRFHR rates were higher in VAD with nuchal cord, the rate of umbilical cord acidemia was not.
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Sankaran D, Lane ECA, Valdez R, Lesneski AL, Lakshminrusimha S. Role of Volume Replacement during Neonatal Resuscitation in the Delivery Room. CHILDREN 2022; 9:children9101484. [PMID: 36291421 PMCID: PMC9601259 DOI: 10.3390/children9101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022]
Abstract
Volume expanders are indicated in the delivery room when an asphyxiated neonate is not responding to the steps of neonatal resuscitation and has signs of shock or a history of acute blood loss. Fetal blood loss (e.g., feto-maternal hemorrhage) may contribute to perinatal asphyxia. Cord compression or a tight nuchal cord can selectively occlude a thin-walled umbilical vein, resulting in feto-placental transfusion and neonatal hypovolemia. For severe bradycardia or cardiac arrest secondary to fetal blood loss, Neonatal Resuscitation Program (NRP) recommends intravenous volume expanders (crystalloids such as normal saline or packed red blood cells) infused over 5 to 10 min. Failure to recognize hypovolemia and subsequent delay in volume replacement may result in unsuccessful resuscitation due to lack of adequate cardiac preload. However, excess volume load in the presence of myocardial dysfunction from hypoxic–ischemic injury may precipitate pulmonary edema and intraventricular hemorrhage (especially in preterm infants). Emergent circumstances and ethical concerns preclude the performance of prospective clinical studies evaluating volume replacement during neonatal resuscitation. Translational studies, observational data from registries and clinical trials are needed to investigate and understand the role of volume replacement in the delivery room in term and preterm neonates. This article is a narrative review of the causes and consequences of acute fetal blood loss and available evidence on volume replacement during neonatal resuscitation of asphyxiated neonates.
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Affiliation(s)
- Deepika Sankaran
- Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
| | - Emily C. A. Lane
- Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
| | - Rebecca Valdez
- Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
| | - Amy L. Lesneski
- Department of Stem Cell Research, University of California, Davis, Sacramento, CA 95817, USA
| | - Satyan Lakshminrusimha
- Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
- Correspondence:
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Prenatal ultrasound-based diagnosis of umbilical cord torsion in one fetus in a twin pregnancy. Eur J Obstet Gynecol Reprod Biol 2021; 261:243-244. [PMID: 33879348 DOI: 10.1016/j.ejogrb.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/11/2021] [Indexed: 11/23/2022]
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Hayes DJL, Warland J, Parast MM, Bendon RW, Hasegawa J, Banks J, Clapham L, Heazell AEP. Umbilical cord characteristics and their association with adverse pregnancy outcomes: A systematic review and meta-analysis. PLoS One 2020; 15:e0239630. [PMID: 32970750 PMCID: PMC7514048 DOI: 10.1371/journal.pone.0239630] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/09/2020] [Indexed: 01/14/2023] Open
Abstract
Objective Current data on the role of the umbilical cord in pregnancy complications are conflicting; estimates of the proportion of stillbirths due to cord problems range from 3.4 to 26.7%. A systematic review and meta-analysis were undertaken to determine which umbilical cord abnormalities are associated with stillbirth and related adverse pregnancy outcomes. Methods MEDLINE, EMBASE, CINAHL and Google Scholar were searched from 1960 to present day. Reference lists of included studies and grey literature were also searched. Cohort, cross-sectional, or case-control studies of singleton pregnancies after 20 weeks’ gestation that reported the frequency of umbilical cord characteristics or cord abnormalities and their relationship to stillbirth or other adverse outcomes were included. Quality of included studies was assessed using NIH quality assessment tools. Analyses were performed in STATA. Results This review included 145 studies. Nuchal cords were present in 22% of births (95% CI 19, 25); multiple loops of cord were present in 4% (95% CI 3, 5) and true knots of the cord in 1% (95% CI 0, 1) of births. There was no evidence for an association between stillbirth and any nuchal cord (OR 1.11, 95% CI 0.62, 1.98). Comparing multiple loops of nuchal cord to single loops or no loop gave an OR of 2.36 (95% CI 0.99, 5.62). We were not able to look at the effect of tight or loose nuchal loops. The likelihood of stillbirth was significantly higher with a true cord knot (OR 4.65, 95% CI 2.09, 10.37). Conclusions True umbilical cord knots are associated with increased risk of stillbirth; the incidence of stillbirth is higher with multiple nuchal loops compared to single nuchal cords. No studies reported the combined effects of multiple umbilical cord abnormalities. Our analyses suggest specific avenues for future research.
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Affiliation(s)
- Dexter J. L. Hayes
- Tommy’s Stillbirth Research Centre, University of Manchester, Manchester, United Kingdom
- * E-mail:
| | - Jane Warland
- University of South Australia, Adelaide, Australia
| | - Mana M. Parast
- University of California, San Diego, CL, United States of America
| | - Robert W. Bendon
- Retired from Norton Children’s Hospital, Louisville, Kentucky, United States of America
| | | | - Julia Banks
- Tommy’s Stillbirth Research Centre, University of Manchester, Manchester, United Kingdom
| | - Laura Clapham
- Tommy’s Stillbirth Research Centre, University of Manchester, Manchester, United Kingdom
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Abstract
OBJECTIVE Umbilical cord abnormalities are commonly cited as a cause of stillbirth, but details regarding these stillbirths are rare. Our objective was to characterize stillbirths associated with umbilical cord abnormalities using rigorous criteria and to examine associated risk factors. METHODS The Stillbirth Collaborative Research Network conducted a case-control study of stillbirth and live births from 2006 to 2008. We analyzed stillbirths that underwent complete fetal and placental evaluations and cause of death analysis using the INCODE (Initial Causes of Fetal Death) classification system. Umbilical cord abnormality was defined as cord entrapment (defined as nuchal, body, shoulder cord accompanied by evidence of cord occlusion on pathologic examination); knots, torsions, or strictures with thrombi, or other obstruction by pathologic examination; cord prolapse; vasa previa; and compromised fetal microcirculation, which is defined as a histopathologic finding that represents objective evidence of vascular obstruction and can be used to indirectly confirm umbilical cord abnormalities when suspected as a cause for stillbirth. We compared demographic and clinical factors between women with stillbirths associated with umbilical cord abnormalities and those associated with other causes, as well as with live births. Secondarily, we analyzed the subset of pregnancies with a low umbilical cord index. RESULTS Of 496 stillbirths with complete cause of death analysis by INCODE, 94 (19%, 95% CI 16-23%) were associated with umbilical cord abnormality. Forty-five (48%) had compromised fetal microcirculation, 27 (29%) had cord entrapment, 26 (27%) knots, torsions, or stricture, and five (5%) had cord prolapse. No cases of vasa previa occurred. With few exceptions, maternal characteristics were similar between umbilical cord abnormality stillbirths and non-umbilical cord abnormality stillbirths and between umbilical cord abnormality stillbirths and live births, including among a subanalysis of those with hypo-coiled umbilical cords. CONCLUSION Umbilical cord abnormalities are an important risk factor for stillbirth, accounting for 19% of cases, even when using rigorous criteria. Few specific maternal and clinical characteristics were associated with risk.
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Sherer DM, Ward K, Bennett M, Dalloul M. Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of Nuchal Cord(s). Int J Womens Health 2020; 12:613-631. [PMID: 32982473 PMCID: PMC7500175 DOI: 10.2147/ijwh.s211124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/17/2020] [Indexed: 11/29/2022] Open
Abstract
Umbilical cord accidents preceding labor are uncommon. In contrast, nuchal cords are a very common finding at delivery, with reported incidences of a single nuchal cord of approximately between 20% and 35% of all singleton deliveries at term. Multiple loops occur less frequently, with reported incidence rates inverse to the number of nuchal cords involved. Rare cases of up to 10 loops of nuchal cord have been reported. While true knots of the umbilical cord have been associated with a 4–10-fold increased risk of stillbirth, nuchal cord(s) are most often noted at delivery of non-hypoxic non-acidotic newborns, without any evidence of subsequent adverse neonatal outcome. Prior to ultrasound, nuchal cords were suspected clinically following subtle (spontaneous or evoked) electronic fetal heart rate changes. Prenatal sonographic diagnosis, initially limited to real-time gray-scale ultrasound, currently entails additional sonographic modalities, including color Doppler, power Doppler, and three-dimensional sonography, which have enabled increasingly more accurate prenatal sonographic diagnoses of nuchal cord(s). In contrast to true knots of the umbilical cord (which are often missed at sonography, reflecting the inability to visualize the entire umbilical cord, and hence are often incidental findings at delivery), nuchal cord(s), reflecting their well-defined and sonographically accessible anatomical location (the fetal neck), lend themselves with relative ease to prenatal sonographic diagnosis, with increasingly high sensitivity and specificity rates. While current literature supports that single (and possibly double) nuchal cords are not associated with increased adverse perinatal outcome, emerging literature suggests that cases of ≥3 loops of nuchal cords or in the presence of a coexisting true knot of the umbilicus may be associated with an increased risk of stillbirth or compromised neonatal status at delivery. This commentary will address current perspectives of prenatal sonographic diagnosis and clinical management challenges associated with nuchal cord(s) in singleton pregnancies.
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Affiliation(s)
- David M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
| | - Kayana Ward
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
| | - Michelle Bennett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
| | - Mudar Dalloul
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
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Umbilical cord arterial blood gas analysis in term singleton pregnancies: a retrospective analysis over 11 years. Obstet Gynecol Sci 2020; 63:293-304. [PMID: 32489974 PMCID: PMC7231949 DOI: 10.5468/ogs.2020.63.3.293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/12/2019] [Accepted: 11/17/2019] [Indexed: 11/29/2022] Open
Abstract
Objective Given that the large volume of data on cord arterial blood gas analysis (ABGA) have been rarely addressed in Korean population, we aimed to examine the incidence, associated factors, and neonatal outcomes in cases of low cord pH, and investigate the incidence of cerebral palsy (CP). Methods From data of all consecutive term singleton pregnancies delivered in our institution from 2006 to 2016 (n=15,701), cases with cord ABGA (n=14,221) available were included. We collected information on maternal clinical characteristics and delivery outcomes and also examined neonatal and infant outcomes, including neonatal intensive care unit (NICU) admission and CP, in cases with low cord pH, defined as a pH <7.1. Results Rates of low Apgar scores at 1 minute (<4) and 5 minutes (<7) were 0.6% (n=79) and 0.4% (n=58), respectively. Rates of cord pH <7.2, <7.1, and <7.0 were 7.1% (n=1,011), 1.1% (n=163), and 0.3% (n=38), respectively. Among cases with low cord pH, 30.1% (n=49/163) were admitted to the NICU and 11.0% (n=18/163) required ventilator support. Ultrasonography of the brain was performed in 28.8% (n=47/163), with abnormal findings observed in 27.7% (n=13/47). Among cases with low cord pH, 1.8% (n=3/163) were subsequently diagnosed with CP, including 2 cases of spastic CP and 1 of ataxic CP. Conclusion Although low cord pH was a relatively frequent finding observed in 1 out of every 87 cases, hypoxic-ischemic encephalopathy-related CP was found in only 1 out of 7,111 term singleton deliveries over 11 years in our institution.
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Sherer DM, Amoabeng O, Dryer AM, Dalloul M. Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of True Knot of the Umbilical Cord. Int J Womens Health 2020; 12:221-233. [PMID: 32273778 PMCID: PMC7115211 DOI: 10.2147/ijwh.s192260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/23/2020] [Indexed: 11/23/2022] Open
Abstract
Umbilical cord accidents preceding labor are rare. Single and multiple nuchal cords, and true knot(s) of the umbilical cord, are often incidental findings noted at delivery of non-hypoxic non-acidotic newborns without any evidence of subsequent adverse neonatal outcome. In contrast to single nuchal cords, true knots of the umbilical cord, which occur in between 0.04% and 3% of all deliveries, have been associated with a reported 4 to 10 fold increased risk of stillbirth. First reported with real-time ultrasound, current widespread application of color Doppler, power Doppler and three-dimension sonography, has enabled increasingly more accurate prenatal sonographic diagnoses of true knot(s) of the umbilical cord. Reflecting the inability to visualize the entire umbilical cord at prenatal ultrasound assessment, despite detailed second and third-trimester scanning, many occurrences of incidental true knot of the umbilical cord remain undetected and are noted only at delivery. Although prenatal sonographic diagnostic accuracy is increasing, false positive sonographic diagnosis of true knot of the umbilical cord cannot be ruled out with certainty, and must continue to be considered clinically. Notwithstanding the inability to diagnose all true knots, currently there is a clear absence of clinical management guidelines by governing bodies regarding patients in whom prenatal sonographic diagnosis of true knot(s) of the umbilical cord is / are suspected. As a result, in many prenatal ultrasound units, suspected sonographic findings suggestive of or consistent with true knot of the umbilical cord are often disregarded, not documented, and patients are not uniformly informed of this potentially life-threatening condition, which carries an associated considerable risk of stillbirth. This commentary will address current perspectives of prenatal sonographic diagnostic and management challenges associated with true knot(s) of the umbilical cord in singleton pregnancies.
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Affiliation(s)
- David M Sherer
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
| | - Opokua Amoabeng
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
| | - Alexandra M Dryer
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
| | - Mudar Dalloul
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
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Carter EB, Chu CS, Thompson Z, Tuuli MG, Macones GA, Cahill AG. Electronic Fetal Monitoring and Neonatal Outcomes when a Nuchal Cord Is Present at Delivery. Am J Perinatol 2020; 37:378-383. [PMID: 30818403 PMCID: PMC7472605 DOI: 10.1055/s-0039-1679866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study aimed to determine the association between nuchal cord, electronic fetal monitoring parameters, and adverse neonatal outcomes. STUDY DESIGN This was a prospective cohort study of 8,580 singleton pregnancies. Electronic fetal monitoring was interpreted, and patients with a nuchal cord at delivery were compared with those without. The primary outcome was a composite neonatal morbidity index. Logistic regression was used to adjust for confounders. RESULT Of 8,580 patients, 2,071 (24.14%) had a nuchal cord. There was no difference in the risk of neonatal composite morbidity in patients with or without a nuchal cord (8.69 vs. 8.86%; p = 0.81). Nuchal cord was associated with category II fetal heart tracing and operative vaginal delivery (OVD) (6.4 vs. 4.3%; p < 0.01). CONCLUSION Nuchal cord is associated with category II electronic fetal monitoring parameters, which may drive increased rates of OVD. However, there is no significant association with neonatal morbidity.
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Affiliation(s)
- Ebony B. Carter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Cheryl S. Chu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Zach Thompson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Methodius G. Tuuli
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - George A. Macones
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Alison G. Cahill
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
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Iwagaki S, Takahashi Y, Chiaki R, Asai K, Matsui M, Katsura D, Yasumi S, Furuhashi M. Umbilical cord length affects the efficacy of amnioinfusion for repetitive variable deceleration during labor. J Matern Fetal Neonatal Med 2020; 35:86-90. [PMID: 32106728 DOI: 10.1080/14767058.2020.1712703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Although amnioinfusion (AI) for repetitive variable deceleration has been reported to reduce the frequency of variable deceleration and cesarean section (CS) rate, CS is sometimes unavoidable even after therapeutic AI. The purpose of this study was to investigate prenatal factors related to the efficacy of therapeutic AI during labor.Methods: This retrospective study investigated 80 singleton pregnancies that underwent transcervical therapeutic AI for repetitive variable deceleration during labor. AI was performed with 500 mL of warmed saline through an intrauterine pressure catheter by gravity infusion. Prenatal factors related to emergency CS for fetal distress even after therapeutic AI were investigated.Results: Emergency CS was performed for 12 of the 80 cases due to fetal distress. Z-score for umbilical cord length was significantly smaller in the CS group (-0.68 SD) than in the vaginal delivery group (0.15 SD, p < .001). No CSs were performed in cases with Z-score for umbilical cord length >-0.05 SD. No significant differences between CS and vaginal delivery groups were seen in gestational age at delivery, cervical dilatation at AI, birth weight, Z-score of birth weight, incidence of the nuchal cord or incidence of abnormal umbilical cord insertion.Conclusions: Therapeutic AI for repetitive variable deceleration was considered useful, in many cases avoiding emergency CS. Short umbilical cord length (lower Z-score) was related to emergency CS after therapeutic AI for repetitive variable deceleration. Umbilical cord length may offer an important factor for assessing the risk of fetal distress that is difficult to avoid, if methods to accurately determine umbilical cord length can be developed.
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Affiliation(s)
- Shigenori Iwagaki
- Departments of Fetal Maternal Medicine, National Nagara Medical Center, Gifu, Japan
| | - Yuichiro Takahashi
- Departments of Fetal Maternal Medicine, National Nagara Medical Center, Gifu, Japan
| | - Rika Chiaki
- Departments of Fetal Maternal Medicine, National Nagara Medical Center, Gifu, Japan
| | - Kazuhiko Asai
- Departments of Fetal Maternal Medicine, National Nagara Medical Center, Gifu, Japan
| | - Masako Matsui
- Departments of Fetal Maternal Medicine, National Nagara Medical Center, Gifu, Japan
| | - Daisuke Katsura
- Departments of Fetal Maternal Medicine, National Nagara Medical Center, Gifu, Japan
| | - Shunsuke Yasumi
- Departments of Fetal Maternal Medicine, National Nagara Medical Center, Gifu, Japan
| | - Madoka Furuhashi
- Departments of Fetal Maternal Medicine, National Nagara Medical Center, Gifu, Japan
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14
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Fouelifack FY, Meche Dahda LC, Fouedjio JH, Fouelifa LD, Enow Mbu R. [Factors associated to the coiling of umbilical cord: case-control study conducted in three hospitals in Yaoundé]. Pan Afr Med J 2020; 35:23. [PMID: 32341744 PMCID: PMC7174007 DOI: 10.11604/pamj.2020.35.23.19365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/20/2019] [Indexed: 02/05/2023] Open
Abstract
Introduction La circulaire du cordon ombilical correspond à l’enroulement du cordon ombilical en un ou plusieurs tours sur une partie du fœtus. Anomalie la plus fréquente du cordon, sa prévalence varie selon les auteurs de 5,7% à 35,1%. En 2011, le taux de mortalité périnatale liée à la circulaire du cordon au Cameroun était de 6,1%. Cependant ses facteurs associés restent peu connus dans notre contexte. Notre objectif était de déterminer les facteurs associés aux circulaires du cordon dans trois hôpitaux de Yaoundé Méthodes Il s’agissait d’une étude analytique de type cas-témoin, réalisée pendant 4 mois dans les maternités de l’Hôpital Central de Yaoundé, du Centre Hospitalier et Universitaire de Yaoundé et du Centre d’Animation Sociale et Sanitaire de Nkoldongo. Pour un cas (nouveau-nés avec circulaire du cordon), on recrutait 2 témoins (nouveau-nés sans circulaire) tous en présentation céphalique, issus de grossesses monofoetales à terme. Les données recueillies étaient compilées sur des fiches techniques préétablies, saisies et analysées grâce aux logiciels Microsoft Excel 2017 et SPSS version 23. Les outils utilisés pour l’analyse étaient la moyenne d’âge, l’écart type et la fréquence, le rapport de cote cru (OR) et/ou ajusté (aOR) avec leur intervalle de confiance à 95%. P était considéré significatif pour toute valeur inférieure à 5% Résultats Sur un total de 3300 accouchements, 500 nouveau-nés soit 15,15% avaient une circulaire du cordon. Toutes les circulaires étaient autour du cou. Nous avons retenu et analysé 136 nouveau-nés avec circulaire du cordon (cas) pour 272 nouveau-nés sans circulaire (témoins). Les facteurs indépendamment associés aux circulaires étaient non modifiables: longueur du cordon = 70cm (ORa = 32 IC = 17,5-35 P = 0,02), sexe masculin (ORa = 67,09 IC = 22,31 - 97,46 P = 0,001), APGAR 5ème minute < 7 (ORa = 76,98 IC =2,19-27,05 P = 0,017), et modifiables: l’âge gestationnel ≥ 42SA (ORa = 15,15 IC = 6,14-18,2 P=0,001) Conclusion La circulaire du cordon est une anomalie fréquente du cordon. Nous suggérons aux décideurs de sensibiliser davantage le personnel de santé et la population sur l’importance de l’échographie du troisième trimestre afin de rechercher et prévoir la prise en charge des nouveau-nés avec circulaire du cordon. Les cliniciens devraient éviter autant que possible le post terme.
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Affiliation(s)
- Florent Ymele Fouelifack
- Hôpital Central de Yaoundé, Yaoundé, Cameroun.,Institut Supérieur de Technologie Médicale de Nkolondom, Yaoundé, Cameroun.,Groupe Associatif pour la Recherche, l'Education et la Santé (GARES-Falaise), Dschang, Cameroun
| | | | - Jeanne Hortence Fouedjio
- Hôpital Central de Yaoundé, Yaoundé, Cameroun.,Faculté de Médicine et des Sciences Biomédicales de l'Université de Yaoundé I, Yaoundé, Cameroun
| | - Loic Dongmo Fouelifa
- Faculté des Sciences de la Santé, Université de Lomé, Ecole des Services de Santé des Armées de Lomé, Lomé, Togo
| | - Robinson Enow Mbu
- Hôpital Central de Yaoundé, Yaoundé, Cameroun.,Faculté de Médicine et des Sciences Biomédicales de l'Université de Yaoundé I, Yaoundé, Cameroun.,Ministère de la Santé Publique, Yaoundé, Cameroun
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15
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Umbilical Cord Abnormalities and Pregnancy Outcome. JOURNAL OF FETAL MEDICINE 2019. [DOI: 10.1007/s40556-019-00217-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Pergialiotis V, Fanaki M, Bellos I, Tzortzis A, Loutradis D, Daskalakis G. Evaluation of umbilical cord entanglement as a predictive factor of adverse pregnancy outcomes: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2019; 243:150-157. [PMID: 31704532 DOI: 10.1016/j.ejogrb.2019.10.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/19/2019] [Accepted: 10/23/2019] [Indexed: 11/28/2022]
Abstract
The purpose of the present systematic review is to summarize current data concerning the impact of umbilical cord entanglement on adverse pregnancy outcomes. We used the Medline, Scopus, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar databases. We selected all observational (both prospective and retrospective) studies for inclusion. Meta-analysis of the risk ratios (RR) was performed with RevMan 5.3 software. Univariate meta-regression and leave-one-out meta-analysis was performed with Open Meta-Analyst statistical software. Trial sequential analysis was performed with the TSA software. Overall, twenty studies were included in the present study with 267,233 pregnant women (50.103 with cord entanglement and 217,130 controls). An increased risk of neonatal Apgar score <7 at the first minute of life was observed among cases with cord entanglement (RR = 1.75, 95% CI 1.46, 2.11). Fetal distress was significantly higher in the entanglement group (RR 1.50, 95% CI 1.33, 1.69). The incidence of fetal pH < 7.1 was also significantly higher in the entanglement group (RR 1.73, 95% CI 1.48, 2.03). Adequate power was observed in all investigated outcomes of our primary analysis after evaluating the results of the TSA analysis. Prediction intervals designated that future studies were likely to report increased risk of low Apgar score at the first minute of life, increased risk of fetal distress as well as of observing a fetal pH < 7.1. Concluding, the findings of this systematic review suggest that there is sufficient evidence to support the involvement of cord entanglement to adverse neonatal perinatal outcomes.
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Affiliation(s)
- Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Greece; First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece.
| | - Maria Fanaki
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Greece
| | - Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Greece
| | - Andrianos Tzortzis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Loutradis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Georgios Daskalakis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
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Sepulveda W. Antenatal course and perinatal outcome after ultrasound detection of triple nuchal cord: a case series. J Matern Fetal Neonatal Med 2019; 34:3246-3251. [PMID: 31451054 DOI: 10.1080/14767058.2019.1659773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the antenatal course and perinatal outcome of pregnancies in which a triple nuchal cord was detected prenatally by ultrasound. METHODS Singleton pregnancies presenting for ultrasound evaluation after 24 weeks of gestation were routinely screened for the presence of nuchal cord loops using two-dimensional and color-Doppler ultrasound. Fetuses with more than two nuchal cord loops were identified from our fetal medicine database and their ultrasound reports and medical records were reviewed. RESULTS During the study period from July 2014 to February 2019, 10 singleton fetuses with triple nuchal cord were identified, for a prevalence of 1 in 506 or 0.2%. No cases of more than three nuchal cord loops were detected. No predisposing factors were identified. Cases detected after 36 weeks (n = 4) delivered by cesarean section after 37 weeks and the diagnosis of triple nuchal cord was confirmed in all of them. Cases detected before 36 weeks (n = 6) underwent fetal surveillance. Among these cases, the umbilical cord unraveled itself from around the fetal neck in at least one loop in 83% of these cases. Overall, eight (80%) of the neonates were delivered by cesarean section for different reasons; in only two, the sole indication for cesarean delivery was the presence of the triple nuchal cord. All the infants had a good perinatal outcome, although one newborn infant was small for gestational age. CONCLUSIONS Ultrasound detection of triple nuchal cord during late pregnancy was associated with good perinatal outcomes. However, this prenatal finding was also associated with a high rate of cesarean section. In preterm pregnancies, multiple loops will reduce spontaneously in the majority of cases, so expectant management is indicated. In term pregnancies, the decision regarding the optimal timing and mode of delivery should be discussed with the parents taking into account the individual clinical scenarios.
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Affiliation(s)
- Waldo Sepulveda
- FETALMED - Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
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18
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Tagliaferri S, Esposito FG, Esposito G, Saccone G, Signorini MG, Magenes G, Campanile M, Guida M, Zullo F. Impact of nuchal cord on antenatal and intrapartum foetal heart rate surveillance and perinatal outcome. J OBSTET GYNAECOL 2019; 40:316-323. [PMID: 31976797 DOI: 10.1080/01443615.2019.1621816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Analysing antepartum and intrapartum computerised cardiotocographic (cCTG) parameters in physiological term pregnancies with nuchal (NC) or body cord (BC), in order to correlate them with labour events and neonatal outcome. We enrolled 808 pregnant women, composed of 264 with 'one NC', 121 with 'multiple NCs', 39 with BC and 384 with 'no NC', were monitored from the 37th week of gestation before labour, while 49 pregnant women with 'one or more NCs' and 47 with 'no NCs' were analysed during labour. No differences in maternal characteristics, foetal pH at birth and 5-min Apgar score were observed. The birth weight was significantly lower in the 'multiple NCs' group, while 1-minute Apgar score was lower in the BC group than the other groups, respectively. No relevant differences in cCTG parameters were observed, except for LTI, Delta and number of variable decelerations in antepartum period and only variable deceleration in intrapartum period.Impact statementWhat is already known on this subject? Ultrasound cannot predict which foetuses with NCs are likely to have problem during labour. The question arose if single or multiple NC could affects FHR monitoring prior and during labour.What do the results of this study add? Computerised cardiotocography (cCTG) is a standardised method developed to reduce inter- and intra-observer variability and the poor reproducibility of visual analysis. Few studies have investigated the influence of NCs on FHR variability and, to our knowledge, no one has evaluated its linear and nonlinear characteristics in antepartum and intrapartum period using a computerised analysis system. No differences in maternal characteristics, foetal pH at birth and 5-min Apgar score were observed. Birth weight was significantly lower in the 'multiple NCs' group, while 1-min Apgar score was lower in the BC group than the other groups, respectively. Foetuses with 'one or more NCs' evidenced a larger number of prolonged second stage and meconium-stained liquor cases, while the operative vaginal delivery and emergency caesarean section rates were unchanged. No relevant differences in cCTG parameters were observed, except for LTI, Delta and number of variable decelerations in antepartum period and only variable deceleration in intrapartum period.What are the implications of these findings for clinical practice and/or further research? cCTG monitoring results confirmed their usefulness for assessing the state of good oxygenation for all foetuses investigated.
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Affiliation(s)
- Salvatore Tagliaferri
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy
| | - Francesca Giovanna Esposito
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy
| | - Giuseppina Esposito
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy
| | - Gabriele Saccone
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy
| | - Maria Gabriella Signorini
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Milano, Italy
| | - Giovanni Magenes
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Marta Campanile
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy
| | - Maurizio Guida
- Department of Gynecology and Obstetrics, University of Salerno, Salerno, Italy
| | - Fulvio Zullo
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy
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19
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Adverse pregnancy outcomes and multiple nuchal cord loops. Arch Gynecol Obstet 2019; 300:279-283. [PMID: 31065803 DOI: 10.1007/s00404-019-05178-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the effects of nuchal cord and the number of loops during labor and delivery on delivery outcomes among women with singleton pregnancy who delivered vaginally. METHODS This retrospective cohort study included 42,798 women with singleton, vertex, and vaginal deliveries at 24-43 weeks of gestation. We analyzed delivery outcomes based on the number of nuchal cord loops. RESULTS A total of 42,798 deliveries met the inclusion criteria, of which, 3809 (8.9%) had nuchal cord with 1 loop at delivery, 1035 (2.42%) had 2 loops, and 258 (0.6%) had 3 loops. Nuchal cord with 3 loops compared to no nuchal cord has been associated with higher incidence of intrauterine fetal death (1.9%), Apgar scores less than 7 at 1 and 5 min (7.4%, 2.3%), and higher rate of operative vaginal deliveries (17.5%). Nuchal cord with 2 or 3 loops was associated with higher incidence of intrauterine growth restriction (10.2%, 11.6%). In a multiple logistic regression model, nuchal cord with 3 loops was an independent risk factor for operative vaginal delivery and Apgar score less than 7 in 1 min. CONCLUSIONS In the case of vaginal delivery in the presence of nuchal cord, as the number of nuchal cord loops increased, so did the number of adverse delivery outcomes. While 3 loops were associated with higher incidence of intrauterine fetal death, intrauterine growth restriction, increased operative vaginal deliveries, and low Apgar scores, 1 loop was not associated with adverse perinatal outcomes.
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20
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Mariya T, Fujibe Y, Shinkai S, Sugita N, Suzuki M, Endo T, Saito T. Multiple part umbilical cord entanglement and neonatal outcomes. Taiwan J Obstet Gynecol 2019; 57:672-676. [PMID: 30342649 DOI: 10.1016/j.tjog.2018.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Umbilical cord entanglement is known to be a major cause of fetal hypoxia and to be correlated with several neonatal complications, but almost all of the previous reports were restricted to nuchal cord. In this study, we retrospectively examined the correlation between multiple part cord entanglement and pregnancy outcomes. MATERIALS AND METHODS A total of 2156 cases were recruited from term deliveries in our hospital from 2008 to 2012. We counted umbilical cord loop numbers not only for nuchal cord but also for trunk and limb cord entanglement. We classified the cases into three groups: no loop, single loop and multiple loops group. We statistically analyzed pregnancy outcomes statistically in the three groups. RESULTS One thousand, four hundred and fifty-eight cases had no cord entanglement, 594 cases had single loop entanglement and 104 cases had multiple loops entanglement. Values of umbilical artery blood, pH (p = 0.002) and base excess (p < 0.001) showed significantly unfavorable status in entanglement cases, especially in the multiple loops group. A significantly larger percentage of neonates in the multiple loops group needed for oxygen (p < 0.001). CONCLUSION Multiple umbilical cord entanglement is highly correlated with early neonatal unfavorable status and need for resuscitation.
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Affiliation(s)
- Tasuku Mariya
- Department of Obstetrics and Gynecology, Hokkaido Social Insurance Obihiro Hospital, Obihiro, Japan; Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Yuya Fujibe
- Department of Obstetrics and Gynecology, Hokkaido Social Insurance Obihiro Hospital, Obihiro, Japan; Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shota Shinkai
- Department of Obstetrics and Gynecology, Hokkaido Social Insurance Obihiro Hospital, Obihiro, Japan; Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoko Sugita
- Department of Obstetrics and Gynecology, Hokkaido Social Insurance Obihiro Hospital, Obihiro, Japan; Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masahiro Suzuki
- Department of Obstetrics and Gynecology, Hokkaido Social Insurance Obihiro Hospital, Obihiro, Japan; Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiaki Endo
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
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21
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Nuchal cord at delivery and perinatal outcomes: Single-center retrospective study, with emphasis on fetal acid-base balance. Pediatr Neonatol 2018; 59:439-447. [PMID: 29581058 DOI: 10.1016/j.pedneo.2018.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 11/17/2017] [Accepted: 03/01/2018] [Indexed: 11/21/2022] Open
Abstract
AIM Our study objectives were to evaluate umbilical cord blood acid-base balance in presence of nuchal cord at delivery, effects of nuchal cord at delivery on perinatal outcomes and incidence of nuchal cord in a racially diverse population. METHODS Perinatal records of 2530 women (predominantly African American and Hispanic) who delivered in 2012 were examined. Perinatal outcomes of women who delivered a baby with nuchal cord were compared with those without nuchal cord. RESULTS In this study, incidence of nuchal cord was 23.5% and incidence of tight nuchal cord was 1.9%; 4.2% of babies with nuchal cord required resuscitation and 3.2% of babies with nuchal cord needed to be admitted to NICU. In our study, 4.2% of babies with nuchal cord required resuscitation and in total 3.2% of babies with nuchal cord needed to be admitted to NICU. Nuchal cord frequency increased from 15.6% at ≤36 weeks to 22.8% at ≥37 weeks. Significantly elevated umbilical cord Veno-Arterial pH differential was noted in babies with nuchal cord, indicating fetal acidemia. CONCLUSIONS Perinatal outcomes of pregnancies with nuchal cord in predominantly African American and Hispanic women were not adversely affected. Analysis of umbilical cord blood gases suggests mixed respiratory and metabolic fetal acidosis.
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22
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Yarcı Gursoy A, Ozgu B, Tasci Y, Candar T, Erkaya S, Caglar GS. The impact of nuchal cord on umbilical cord blood gas analysis and ischaemia-modified albumin levels in elective C-section. J OBSTET GYNAECOL 2018; 38:1099-1103. [PMID: 29912599 DOI: 10.1080/01443615.2018.1454411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This study was designed to evaluate umbilical cord ischaemia-modified albumin (IMA) levels and the cord blood gas parameters of foetuses with or without nuchal cords, at the time of elective C-section. The cross-sectional study population consisted of the patients who were admitted to the Tertiary Care Center between February and June 2015. Women with uncomplicated single term gestations between 37 and 40 completed weeks and scheduled for elective C-sections were included in the study. Fifty cases with a nuchal cord and 50 cases without a nuchal cord were recruited. Nuchal cord blood gas analysis and the IMA levels were evaluated. The IMA levels in umbilical artery of foetuses both in the study and control groups were similar (0.714 ± 0.150 vs. 0.689 ± 0.107 ABSU, p = .340, respectively). The umbilical artery pH values of the study group were significantly lower than that in the control group (7.31 ± 0.04 vs. 7.32 ± 0.03, p = .042; respectively). The results of the current study indicate that the nuchal cord has an impact on the foetal cord blood gas parameters to some extent before the initiation of labour. Fortunately, this impact does not end up with foetal tissue ischaemia, as confirmed by the IMA levels. Impact statement What is already known on this subject? The impact of nuchal cord on perinatal outcomes has been the subject of research for many years. Although the accumulated data has pointed out some unfavourable perinatal effects, the heterogeneity of the study groups both including a vaginal delivery and C-section and the inability to adjust the interfering factors ended up with some controversies. This is why there is not much known about the effects of the nuchal cord in women who are not in the labour process. What do the results of this study add? The current study aimed to exclude the interfering effects such as the active stage of labour. In this study, elective caesarean sections were selected as the study population to evaluate the effects of the nuchal cord on cord blood gas parameters and the IMA values. pH analysis in cord blood is used to detect hypoxia and the IMA is a new ischaemia marker. The results revealed that the in utero nuchal cord is associated with a significantly higher pCO2 and lower pH values and similar IMA values. What are the implications of these findings for clinical practice and/or further research? The final outcome supports that the nuchal cord causes alterations in cord blood gas analysis but this does not reach critical levels. Therefore, the results show that there is no need to change clinical practice when the nuchal cord is detected by ultrasound in a term gestation.
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Affiliation(s)
- Aslı Yarcı Gursoy
- a Department of Obstetrics and Gynecology , Ufuk University Faculty of Medicine , Ankara , Turkey
| | - Burcin Ozgu
- b Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Care and Research Hospital , Ankara , Turkey
| | - Yasemin Tasci
- b Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Care and Research Hospital , Ankara , Turkey
| | - Tuba Candar
- c Department of Biochemistry , Ufuk University Faculty of Medicine , Ankara , Turkey
| | - Salim Erkaya
- b Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Care and Research Hospital , Ankara , Turkey
| | - Gamze Sinem Caglar
- a Department of Obstetrics and Gynecology , Ufuk University Faculty of Medicine , Ankara , Turkey
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23
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Akkaya H, Uysal G, Büke B, Gök G, Erel Ö, Karakükçü Ç. Evaluation of fetal serum thiol/disulphide homeostasis in deliveries complicated by nuchal cord. J Matern Fetal Neonatal Med 2018; 32:3543-3547. [DOI: 10.1080/14767058.2018.1466273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Hatice Akkaya
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Gülsüm Uysal
- Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Barış Büke
- Department of Perinatology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Gamze Gök
- Department of Clinical Biochemistry, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Özcan Erel
- Department of Clinical Biochemistry, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Çiğdem Karakükçü
- Department of Clinical Biochemistry, Kayseri Training and Research Hospital, Kayseri, Turkey
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24
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Abdallah A, Eldorf A, Sallam S, Ahmed S, Shawky M, Nawara M, El-sayed M, Islam B, Abdelrahman R, Sabaa H, BahaaEldin A, Yehia A, Rateb A, Sakna N, Mamdouh A, Taema M, Elshourbagy M, Alanwar A. Nuchal cord: impact of umbilical artery Doppler indices on intrapartum and neonatal outcomes: a prospective cohort study. J Matern Fetal Neonatal Med 2018; 32:3367-3378. [DOI: 10.1080/14767058.2018.1463984] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- A. Abdallah
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
| | - A. Eldorf
- Department of Obstetrics and Gynecology, Tanta University, Elgharbya, Egypt
| | - S. Sallam
- Dar El Teb Infertility Hospital, Cairo, Egypt
| | - S. Ahmed
- Fetal medicine unit, Cairo University, Cairo, Egypt
| | - M. Shawky
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M. Nawara
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M. El-sayed
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ba Islam
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - R. Abdelrahman
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - H. Sabaa
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - A. BahaaEldin
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - A. Yehia
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - A. Rateb
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - N. Sakna
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - A. Mamdouh
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M. Taema
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M. Elshourbagy
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - A. Alanwar
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Hasegawa J. Ultrasound screening of umbilical cord abnormalities and delivery management. Placenta 2018; 62:66-78. [DOI: 10.1016/j.placenta.2017.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 12/26/2022]
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Peripartum events associated with severe neurologic morbidity and mortality among acidemic neonates. Arch Gynecol Obstet 2018; 297:877-883. [PMID: 29335781 DOI: 10.1007/s00404-018-4657-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To identify peripartum events that may predict the development of short-term neurologic morbidity and mortality among acidemic neonates. METHODS Retrospective case-control study conducted at a single-teaching hospital on data from January 2010 to December 2015. The study cohort group included all acidemic neonates (cord artery pH ≤ 7.1) born at ≥ 34 weeks. Primary outcome was a composite including any of the following: neonatal encephalopathy, convulsions, intra-ventricular hemorrhage, or neonatal death. The study cohort was divided to the cases group, i.e., acidemic neonates who had any component of the primary outcome, and a control group, i.e., acidemic neonates who did not experience any component of the primary outcome. RESULTS Of all 24,311 neonates born ≥ 34 weeks during the study period, 568 (2.3%) had a cord artery pH ≤ 7.1 and composed the cohort study group. Twenty-one (3.7%) neonates composed the cases group. Multivariate logistic regression analysis revealed that cases were significantly more likely to have experienced placental abruption (OR 18.78; 95% CI 5.57-63.26), born ≤ 2500 g (OR 13.58; 95% CI 3.70-49.90), have meconium (OR 3.80; 95% CI 1.20-11.98) and cord entanglement (OR 5.99; 95% CI 1.79-20.06). The probability for developing the composite outcome rose from 3.7% with isolated acidemia to 97% among neonates who had all these peripartum events combined with intrapartum fetal heart rate tracing category 2 or 3. CONCLUSION Neonatal acidemia carries a favorable outcome in the vast majority of cases. In association with particular antenatal and intrapartum events, the short-term outcome may be unfavorable.
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Abstract
Nuchal cord occurs when the umbilical cord becomes wrapped around the fetal neck 360 degrees. Nuchal cords occur in about 10–29% of fetuses and the incidence increases with advancing gestation age. Most are not associated with perinatal morbidity and mortality, but a few studies have shown that nuchal cord can affect the outcome of delivery with possible long-term effects on the infants. Nuchal cords are more likely to cause problems when the cord is tightly wrapped around the neck, with effects of a tight nuchal cord conceptually similar to strangulation. Umbilical cord compression due to tight nuchal cords may cause obstruction of blood flow in thin walled umbilical vein, while infant’s blood continues to be pumped out of the baby through the thicker walled umbilical arteries causing hypovolemia, acidosis and anemia. Some of these infants have physical features secondary to tight nuchal cords that are distinct from those seen with birth asphyxia. The purpose of this article is to review the pathophysiology of tight nuchal cords and explore gaps in knowledge and research areas.
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Affiliation(s)
- Morarji Peesay
- Department of Pediatrics Division of Neonatal Perinatal Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Rd, NW; Suite M3400, Washington, DC 20007 USA
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Umbilical cord entanglement’s frequency and its impact on the newborn. Int J Legal Med 2017; 132:747-752. [DOI: 10.1007/s00414-017-1746-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
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Boujenah J, Fleury C, Pharisien I, Benbara A, Tigaizin A, Bricou A, Carbillon L. [Cord accident after external cephalic version: Reality or mostly myth?]. ACTA ACUST UNITED AC 2017; 45:9-14. [PMID: 28238321 DOI: 10.1016/j.gofs.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To study the occurrence of cords accident (nuchal cords, prolapse, and braces) after external cephalic version according to its failure or success. METHODS Retrospective study between 1998-2015 comparing in the cord accident diagnosed at delivery (by midwife or doctors according to mode of delivery): Patients with attempt ECV: Group 1 cephalic presentation after successful ECV with trial of labor, and Group 2 failed ECV followed by elective cesarean or trial of labor. Patients with no attempt ECV Group 3 spontaneous cephalic presentation matching for delivery date, maternal age, parity, body mass index, and delivery history with group 1, Group 4 Breech presentation without attempt ECV with trial of labor. RESULTS A total of 776 women with breech presentation were included (198 in group 1, 446 in group 2, 396 in group 3 and 118 in group 4). The prevalence of cord accident did not differ according to ECV attempt (17.08 % versus 18.9 %), to cephalic presentation (group 1: 24.7 % versus group 3: 25 %) and to breech presentation (group 2: 16.9 % versus group 4: 17.2 %). The trial of labor after failed ECV did not increase the risk of cord accident when compared with elective cesarean (17.4 % versus 16 %). A prolapse cord was only observed after trial of labor, i.e. in groups 1, 2 and 4 without difference (respectively 1, 0.8 and 1.7 %). In each group, the rate of cesarean was not different according to the presence of nuchal cord. CONCLUSION Success or failed External cephalic version is not associated with an increased risk of cord accident.
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Affiliation(s)
- J Boujenah
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine-Saint-Denis, site Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; UFR SMBH, université Paris 13, Sorbonne Paris cité, 93000 Bobigny, France.
| | - C Fleury
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine-Saint-Denis, site Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - I Pharisien
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine-Saint-Denis, site Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; UFR SMBH, université Paris 13, Sorbonne Paris cité, 93000 Bobigny, France
| | - A Benbara
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine-Saint-Denis, site Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - A Tigaizin
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine-Saint-Denis, site Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - A Bricou
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine-Saint-Denis, site Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; UFR SMBH, université Paris 13, Sorbonne Paris cité, 93000 Bobigny, France
| | - L Carbillon
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine-Saint-Denis, site Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; UFR SMBH, université Paris 13, Sorbonne Paris cité, 93000 Bobigny, France
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Akkaya H, Büke B, Pekcan MK, Şahin K, Uysal G, Yeğin GF, Avşar AF, Çağlı F. Nuchal cord: is it really the silent risk of pregnancy? J Matern Fetal Neonatal Med 2016; 30:1730-1733. [PMID: 27585242 DOI: 10.1080/14767058.2016.1223035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the relationship between entanglement of umbilical cord around the fetal neck and adverse perinatal outcomes. METHODS In this prospective cohort study, perinatal outcomes of 218 pregnancies complicated with nuchal cord (NC) (study group) were compared with 190 uncomplicated pregnancies (control group). Main outcome measures were umbilical cord pH values, APGAR scores and cesarean section (C/S) rates. Fetal distress was stated as an abnormal heart rate pattern on electronic fetal heart monitorization. RESULTS There were no statistically significant differences in maternal demographic and obstetric features, between groups. There were no statistically significant differences regarding C/S rates between groups, even though fetal distress was significantly the leading indication for cesarean delivery, in the study group (p = 0.021). The number of entanglement was significantly related with fetal distress (p < 0.001). There were no statistically significant differences in umbilical cord gas values, one-minute and five-minute APGAR scores between the groups. Furthermore, there was a significant male dominance in the study group (p = 0.014) and also, amniotic fluid indexes (AFI) were significantly higher in this group (p = 0.002). CONCLUSION This study demonstrated that, entanglement of umbilical cord around the fetal neck or NC is not related with adverse perinatal outcomes such as acidosis and low APGAR scores. So that, a targeted care on NC via ultrasound during labor, is not an essential part of the examination.
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Affiliation(s)
- Hatice Akkaya
- a Department of Gynecology and Obstetrics , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Barış Büke
- a Department of Gynecology and Obstetrics , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Meryem Kuru Pekcan
- b Obstetrics and Gynecology Medicine, Dr Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Kıvanç Şahin
- c Gynecology and Obstetrics Clinic, Kayseri Memorial Private Hospital , Kayseri , Turkey , and
| | - Gülsüm Uysal
- a Department of Gynecology and Obstetrics , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Gülin Feykan Yeğin
- d Department of Gynecology and Obstetrics , Ankara Atatürk Training and Research Hospital , Ankara , Turkey
| | - Ayşe Filiz Avşar
- d Department of Gynecology and Obstetrics , Ankara Atatürk Training and Research Hospital , Ankara , Turkey
| | - Fulya Çağlı
- a Department of Gynecology and Obstetrics , Kayseri Training and Research Hospital , Kayseri , Turkey
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Wang L, Kuromaki K, Kawabe A, Kikugawa A, Matsunaga S, Takagi A. Nuchal cord complication in male small for gestational age increases fetal distress risk during labor. Taiwan J Obstet Gynecol 2016; 55:568-74. [DOI: 10.1016/j.tjog.2016.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 01/13/2023] Open
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Gurau D, Zaltz A, Yoo WK, Rahmani MR. All Tied Up and Nowhere to Go: Report of a Figure-eight Umbilical Cord Complex True Knot and Triple Nuchal Cord Detected on Antenatal Sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1361-1363. [PMID: 27235460 DOI: 10.7863/ultra.15.09044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- David Gurau
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Arthur Zaltz
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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Kuehnle E, Herms S, Kohls F, Kundu S, Hillemanns P, Staboulidou I. Correlation of fetal scalp blood sampling pH with neonatal outcome umbilical artery pH value. Arch Gynecol Obstet 2016; 294:763-70. [DOI: 10.1007/s00404-016-4053-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/16/2016] [Indexed: 11/28/2022]
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Yamamoto Y, Aoki S, Oba MS, Seki K, Hirahara F. Relationship Between Short Umbilical Cord Length and Adverse Pregnancy Outcomes. Fetal Pediatr Pathol 2016; 35:81-7. [PMID: 26735975 DOI: 10.3109/15513815.2015.1122126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To investigate how umbilical cord length relates to pregnancy outcomes, we retrospectively analyzed data from 89,042 deliveries recorded in the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System. We included term deliveries in which vaginal birth was attempted. Umbilical cord length was categorized into four groups: less than the first percentile, from the first percentile to less than the 10th percentile, from the 10th percentile to less than 25th percentile, and from the 25th percentile to less than the 75th percentile, which constituted the control group. Cord lengths of 33, 43, 48, 63 cm corresponded to the first, 10th, 25th, and 75th percentile values of the cord length distribution, respectively. Statistically significant differences were observed in the rate of unplanned cesarean delivery for all three short cord groups compared to control. There was a higher odds ratio for unplanned cesarean delivery as the umbilical cord became shorter.
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Affiliation(s)
- Yuriko Yamamoto
- a Yokohama City University Medical Center , Perinatal Center for Maternity and Neonate , Yokohama , Japan
| | - Shigeru Aoki
- a Yokohama City University Medical Center , Perinatal Center for Maternity and Neonate , Yokohama , Japan
| | - Mari S Oba
- b Department of Medical Statistics , Toho University , Tokyo , Japan
| | - Kazuo Seki
- a Yokohama City University Medical Center , Perinatal Center for Maternity and Neonate , Yokohama , Japan
| | - Fumiki Hirahara
- c Department of Obstetrics and Gynecology , Yokohama City University Hospital , Yokohama , Japan
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Weiner E, Fainstein N, Schreiber L, Sagiv R, Bar J, Kovo M. The association between umbilical cord abnormalities and the development of non-reassuring fetal heart rate leading to emergent cesarean deliveries. J Perinatol 2015; 35:919-23. [PMID: 26291780 DOI: 10.1038/jp.2015.102] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To study the contribution of umbilical cord (UC) abnormalities in emergent cesarean deliveries (ECDs) for non-reassuring fetal heart rate (NRFHR) and to explore their association with placental histopathology and neonatal outcome. STUDY DESIGN Data from 530 ECDs for NRFHR were reviewed for the occurrence of UC abnormalities. Those included the presence of UC entanglements, the number and location of loops, true knots and short cord (<50 cm). Multiple UC entanglements were defined as ⩾ 2 UC loops. Results were compared with 530 vaginal deliveries (VD group) matched for maternal age, parity and gestational age. Additionally, we compared neonatal outcome and placental histopathology in cases of ECDs with a single vs multiple UC entanglements. Neonatal outcome consisted of low Apgar score (⩽ 7 at 5 min), cord blood pH ⩽ 7.1 and composite neonatal outcome that was defined as one or more of respiratory distress, necrotizing enterocolitis, sepsis, transfusion, ventilation, seizure, hypoxic-ischemic encephalopathy, phototherapy or death. Placental lesions were classified as: lesions related to maternal vascular supply, lesions related to fetal vascular supply (consistent with fetal thrombo-occlusive disease), and maternal and fetal inflammatory responses. RESULTS UC entanglements, true knots and short cords were all more common in the ECD group compared with the VD group, P<0.001, P=0.002, P=0.004, respectively. The rate of one loop entanglement did not differ between the groups. The rate of multiple UC entanglements was higher in the ECD group compared with the VD group, 20.6% vs 6.4%, respectively, P<0.001. ECDs with multiple compared with single UC entanglement had higher rate of adverse neonatal outcome, P=0.031, and more placental fetal vascular lesions 19.3% vs 8.1%, P=0.027, respectively. CONCLUSION Multiple UC entanglements, true knots and short cords were more common in ECDs for NRFHR, suggesting their role in the development of fetal placental vascular lesions and adverse neonatal outcome.
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Affiliation(s)
- E Weiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - N Fainstein
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - L Schreiber
- Department of Pathology, Edith Wolfson Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - R Sagiv
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - J Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - M Kovo
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
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Effect of Umbilical Cord Entanglement and Position on Pregnancy Outcomes. Obstet Gynecol Int 2015; 2015:342065. [PMID: 26240566 PMCID: PMC4512586 DOI: 10.1155/2015/342065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 06/29/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction. To investigate the effect of complex umbilical cord entanglement primarily around the trunk on pregnancy outcomes. Methods. We studied 6307 pregnant women with singleton pregnancies who underwent vaginal delivery of an infant at ≥37 weeks of gestation. Cases were classified into no cord, nuchal cord, and body cord groups and defined as cases without umbilical cord entanglement, one or more loops of the umbilical cord around the neck only, and umbilical cord around the trunk only, respectively. Pregnancy outcomes were compared among these three groups. Results. The no cord, nuchal cord, and body cord group included 4733, 1451, and 123 pregnancies, respectively. Although delivery mode was not significantly different among the three groups, 1-minute Apgar scores <7 and umbilical artery (UA) pH <7.10 were significantly more common in the umbilical cord entanglement groups than in the no cord group. In particular, the frequency of 5-minute Apgar scores <7 was significantly higher (P = 0.004), whereas that of UA pH <7.10 tended to be higher (P = 0.057) in the body cord group than in the nuchal cord group. Conclusion. Compared to nuchal cord, umbilical cord entanglement around the trunk was associated with a higher risk of low Apgar scores and low UA pH.
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Weiner E, Bar J, Fainstein N, Schreiber L, Ben-Haroush A, Kovo M. Intraoperative findings, placental assessment and neonatal outcome in emergent cesarean deliveries for non-reassuring fetal heart rate. Eur J Obstet Gynecol Reprod Biol 2015; 185:103-7. [DOI: 10.1016/j.ejogrb.2014.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 11/27/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
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Kong CW, Chan LW, To WWK. Neonatal outcome and mode of delivery in the presence of nuchal cord loops: implications on patient counselling and the mode of delivery. Arch Gynecol Obstet 2015; 292:283-9. [DOI: 10.1007/s00404-015-3630-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
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Petrova T, Lučovnik M. Vpliv ovite popkovnice na pojavnost operativnega dokončanja poroda. OBZORNIK ZDRAVSTVENE NEGE 2014. [DOI: 10.14528/snr.2014.48.3.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Pojavnost ovite popkovnice ob porodu je po tujih podatkih 6–37 %. Ovita popkovnica je lahko povezana z nekaterimi zapleti v nosečnosti, vendar njen vpliv na fetalni distres med porodom in operativno dokončanje poroda še ni dovolj raziskan.
Metode: Izvedli smo retrospektivno kohortno raziskavo podatkov Perinatalnega informacijskega sistema Republike Slovenije za obdobje 2002–2011. Vključili smo enojčke, rojene v glavični vstavi med 37. in 42. tednom. S testom hi-kvadrat smo ugotavljali povezavo med ovito popkovnico in operativnim dokončanjem poroda. Z multiplo logistično regresijo smo poleg vpliva ovite popkovine analizirali še potencialno moteče dejavnike: pariteta, trajanje poroda 9 ur in več, porodna teža pod 5. centilo in začetek poroda.
Rezultati: Vključili smo 173.776 porodov. Popkovnica je bila ovita pri 57.174 (33 %). Ovita popkovnica je bila v univariatni analizi povezana z operativnim dokončanjem poroda (p < 0,001), vendar v multivariatni analizi ni bila neodvisni dejavnik tveganja (p = 0,311), pač pa so to bili prva nosečnost, dolgotrajni porod, indukcija in porodna teža pod 5. centilo (p < 0,001).
Diskusija in zaključek: V slovenskih porodnišnicah je med porodi enojčkov v glavični vstavi ob terminu 33 % takih z ovito popkovnico, kar je več, kot navaja večina tujih raziskav. Ovita popkovnica ni neodvisni dejavnik tveganja za operativno dokončanje poroda.
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Ergin RN, Yayla M, Ergin AS. Fetal demise due to cord entanglement in the early second trimester. Proc (Bayl Univ Med Cent) 2014; 27:143-4. [PMID: 24688205 DOI: 10.1080/08998280.2014.11929092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
In this report, we describe a rare cause of in utero fetal death, a complex entanglement of the umbilical cord around the fetal neck. At the 16th gestational week of pregnancy, routine fetal ultrasonography showed no fetal heartbeat. Thereafter, the fetus was delivered vaginally in the breech presentation. The neck was found to be encircled by multiple tight loops of the umbilical cord. Other than a thin and elongated neck, there were no dysmorphic features and no chromosomal abnormality on cytogenetic analysis.
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Affiliation(s)
- Rahime Nida Ergin
- Department of Gynecology and Obstetrics, Bahcesehir University, Istanbul, Turkey (R. Ergin); the Department of Gynecology and Obstetrics, International Hospital, Istanbul, Turkey (Yayla); and the Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey (A. Ergin)
| | - Murat Yayla
- Department of Gynecology and Obstetrics, Bahcesehir University, Istanbul, Turkey (R. Ergin); the Department of Gynecology and Obstetrics, International Hospital, Istanbul, Turkey (Yayla); and the Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey (A. Ergin)
| | - Ayse Seda Ergin
- Department of Gynecology and Obstetrics, Bahcesehir University, Istanbul, Turkey (R. Ergin); the Department of Gynecology and Obstetrics, International Hospital, Istanbul, Turkey (Yayla); and the Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey (A. Ergin)
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Narang Y, Vaid NB, Jain S, Suneja A, Guleria K, Faridi MMA, Gupta B. Is nuchal cord justified as a cause of obstetrician anxiety? Arch Gynecol Obstet 2014; 289:795-801. [PMID: 24190695 DOI: 10.1007/s00404-013-3072-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 10/24/2013] [Indexed: 02/08/2023]
Abstract
PURPOSE Birth asphyxia leading to acidosis comprises 20-60 % of perinatal mortality. Nuchal cord (NC) is one of the possible causes of birth asphyxia. Majority of fetuses who are antenatally detected to have nuchal cord are able to achieve successful vaginal birth. The purpose of this study was to analyze the effect of nuchal cord on fetal acid base status and perinatal outcome in vaginal deliveries. STUDY DESIGN 150 parturients were equally divided into three groups after vaginal delivery based on no NC, single and multiple loops. Umbilical cord arterial blood was analyzed for biochemical markers i.e. pH, PO2, SPO2, PCO2, HCO3 (-), standard base excess and lactate for acidosis. Labor complications like abnormal FHR, meconium-stained liquor, prolonged second stage, instrumental vaginal delivery, third stage complications were compared. In neonates, birth weight, Apgar score ≤7 at 5 min, NICU admission and other morbidity and mortality during hospital stay were compared among groups using suitable statistical tests. Above parameters were also compared between tight and loose loops. RESULT Nuchal cord groups had significantly higher frequency of labor complications than no NC group, especially tight loops. Neonates with NC had significantly higher frequency of meconium-stained liquor, Apgar score ≤7 at 5 min, deranged biochemical markers, NICU transfer. However, none of the neonate had pH in acidosis range and majority were discharged in healthy condition. CONCLUSION Patients with NC are likely to have uneventful labor and delivery as cord compression is transient and most fetuses are able to compensate for reduce umbilical blood flow. Routine antenatal ultrasound scan is not advisable, as mode of delivery and labor management does not change with detection of NC antenatally. Therefore, vaginal delivery with routine labor protocol can be allowed in cases of nuchal cord.
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Affiliation(s)
- Yum Narang
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and GTB Hospital, Dilshad Garden, New Delhi, India
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Chan JSY, Baergen RN. Gross umbilical cord complications are associated with placental lesions of circulatory stasis and fetal hypoxia. Pediatr Dev Pathol 2012; 15:487-94. [PMID: 22978619 DOI: 10.2350/12-06-1211-oa.1] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Umbilical cord complications (UCC), such as true knots (TK), velamentous (VEL) insertion, marginal umbilical cord (MUC) insertion, umbilical cord entanglement (UCE) (both nuchal and non-nuchal), excessively long umbilical cord (ELUC), and excessively twisted umbilical cord (ETUC), can lead to decreased UC blood flow and have been associated with adverse fetal outcome and intrauterine fetal demise (IUFD). Few large series exist that correlate UCC with specific pathologic findings of the placenta. We present the largest series of UCC at this time. Eight hundred forty-one 3rd-trimester placentas with UCC were identified, as well as 858 randomly selected gestational age-matched placentas with grossly unremarkable UC. Lesions associated with circulatory stasis and thrombosis, including villous capillary congestion (VC), umbilical vessel distension (UVD), chorionic plate vessel distension (CPD), umbilical vessel thrombosis (UVT), fetal vascular thrombosis (FVT), intimal fibrin cushions (IFC), and avascular villi (AV), were noted, as well as other pathologic lesions. Data were analyzed by analysis of variance and Fisher exact tests, with P < 0.05 statistically significant. Umbilical cord complications as a group was associated with a significant increase in placental circulatory stasis lesions. Lesions associated with hypoxia, namely nucleated red blood cells and chorangiosis, were also increased. Finally, the presence of any UCC was significantly associated with IUFD. We also found that multiple UCC are associated with nonreassuring fetal heart rate and chorangiosis but that the presence of a single UCC was not. This indicates that UCC may lead to intrauterine hypoxia and subsequent adverse fetal outcome and that multiple UCC may be cumulative in effect.
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Affiliation(s)
- Joanna S Y Chan
- Department of Pathology & Laboratory Medicine, New York Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.
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Hoh JK, Sung YM, Park MI. Fetal heart rate parameters and perinatal outcomes in fetuses with nuchal cords. J Obstet Gynaecol Res 2011; 38:358-63. [PMID: 22176493 DOI: 10.1111/j.1447-0756.2011.01707.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The purpose of the present study was to compare and analyze differences in antepartal fetal heart rate (FHR) parameters during pregnancy and pregnancy outcomes in normal fetuses and fetuses with nuchal cord (NC). MATERIAL AND METHODS We surveyed all non-stress test (NST) data acquired using a computerized FHR analysis system at Hanyang University Hospital between 2005 and 2008, and selected 150 cases that had NC. NSTs were performed between 37 and 42 weeks of gestation. Subjects were divided into three groups by the number of NCs: no NC and normal (n = 300), single (n = 124) and multiple NCs (n = 26). Neonatal outcomes were compared, and FHR parameters analyzed using computerized fetal monitoring system. RESULTS FHR variability, with respect to amplitude (AMP) and mean minute range (MMR), was lower in the multiple NCs group than in the normal group (18.04 ± 0.38 vs 14.54 ± 1.10 bpm, P = 0.0207; 55.69 ± 1.22 vs 44.35 ± 3.41 ms, P = 0.0145, respectively). There were no other statistically significant differences of FHR parameters between the three groups. Baby weight was significantly lower in the multiple NCs group than in the normal group (3317 ± 24 vs 3054 ± 55; P = 0.0008), and there were no other significant differences between the groups. CONCLUSION Computerized analysis of FHR would be helpful to assess fetal status, especially in cases of multiple NCs. Multiple NCs may be a subliminal risk factor for the babies even though they present no complications at delivery.
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Affiliation(s)
- Jeong-Kyu Hoh
- Department of Obstetrics and Gynecology, Hanyang University Hospital, Seoul, Korea
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Jackson H, Melvin C, Downe S. Midwives and the Fetal Nuchal Cord: A Survey of Practices and Perceptions. J Midwifery Womens Health 2010; 52:49-55. [PMID: 17207751 DOI: 10.1016/j.jmwh.2006.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A systematic search of studies of intrapartum management of the nuchal umbilical cord at term found no published controlled studies in this area. A postal survey containing both structured and open questions and a request for local protocols and guidelines was sent to all 637 midwives in 7 maternity units in England. There were 401 (63%) responses. There appeared to be no unit guidelines for this area of practice. Midwife approaches to nuchal cord during birth varied, and included clamping and cutting of loose nuchal cords and a hands-off approach to tight nuchal cords. Reasons for specific actions included doing what had been taught during midwifery training and learning from previous personal experiences. Theories of diffusion of innovation and of planned behaviour may provide a conceptual basis for understanding the adoption of specific practices. Future qualitative and controlled studies are needed to explore the nature and consequences of varying approaches to intrapartum nuchal cord management.
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Affiliation(s)
- Hilary Jackson
- Women's Health Unit, Burnley General Hospital, Casterton Avenue, Burnley, Lancashire, BB10 2PQ, England, UK.
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Onan A, Kurdoglu M, Sancak B, Bukan N, Yildirim M. Lipid peroxidation in nuchal cord cases: implication for fetal distress. J Matern Fetal Neonatal Med 2009; 22:254-8. [PMID: 19089774 DOI: 10.1080/14767050802556034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine whether nuchal cord affects fetal lipid peroxidation and cord arterial blood gases, and thus to determine whether lipid peroxidation can show intrapartum distress. METHODS Pregnant women giving birth to a baby with nuchal cord (n = 32) formed the study group and others without this condition made up the control group (n = 36). The maternal malondialdehyde levels (MDA) before and after delivery as well as fetal umbilical cord MDA and arterial blood gases were measured in both the groups. RESULTS Mean cord MDA level was higher in the study group (p < 0.02) and was significantly higher than maternal MDA level after birth within the same group (p = 0.007). Cord blood gases as well as neonatal and labour characteristics showed no difference, except for variable decelerations, which were 2.2 times more common in the study group. Correlations between maternal MDA levels before and after delivery, umbilical cord MDA and arterial blood gases were non-significant in the nuchal cord group. CONCLUSIONS During delivery, nuchal cord increases lipid peroxidation without causing significant fetal acidemia. Level of lipid peroxidation may be a more sensitive indicator of intrapartum distress than results of acid-base studies.
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Affiliation(s)
- Anil Onan
- Department of Obstetrics and Gynecology, Gazi University School of Medicine, Ankara, Turkey
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Abstract
BACKGROUND Nuchal cords are rarely associated with significant neonatal morbidity or mortality. CASE A primigravida with a normal term pregnancy presented for diminished fetal movement. Several nuchal cord loops were found on the ultrasound imaging, with normal Doppler findings. Abnormal fetal heart rate pattern appeared after 6 hours of labor. A cesarean delivery was performed. A healthy baby was born with eight nuchal cord loops. CONCLUSION The management of nuchal cord with a single loop, suspected before delivery, seems clear: it should not influence the clinical management. However, in this case, the previous knowledge of multiple nuchal loops may have influenced our decision to perform a cesarean delivery.
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Lal N, Deka D, Mittal S. Does the nuchal cord persist? An ultrasound and color-Doppler-based prospective study. J Obstet Gynaecol Res 2008; 34:314-7. [PMID: 18686343 DOI: 10.1111/j.1447-0756.2007.00695.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To study the persistence of nuchal cord by ultrasound at various periods of gestation. METHODS Ultrasound was done on 200 consecutive pregnant women and nuchal cord was documented at 18-20, 30-32 and 36-38 weeks' gestation. RESULTS The incidence of nuchal cord was 6% at 18-20 weeks, 7.5% at 30-32 weeks, 26.5% at 36-38 weeks and 28% at birth. The persistence of nuchal cord was 8.3% from 18 to 20 to 30-32 weeks, 26.6% from 30-32 to 36-38 weeks and 84.9% from 36-38 weeks to delivery. Using the Friedman test, the change in the presence of nuchal cord was significant (P < 0.001). CONCLUSIONS Nuchal cord keeps appearing and disappearing over time. Its
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Affiliation(s)
- Neena Lal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
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Ghosh GS, Gudmundsson S. Nuchal cord in post-term pregnancy - relationship to suspected intrapartum fetal distress indicating operative intervention. J Perinat Med 2008; 36:142-4. [PMID: 18211253 DOI: 10.1515/jpm.2008.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Color Doppler Ultrasound was performed on 202 post-term pregnancies to detect the presence of a nuchal cord. A nuchal cord was diagnosed if the umbilical cord could be followed 360 degrees around the fetal neck. The results were not disclosed to the managing obstetrician, midwife, and patient. The perinatal outcome was analyzed according to Apgar score, umbilical cord artery and vein pH and base excess (BE), perinatal death, cesarean section, operative delivery for fetal distress (ODFD) and admission to neonatal intensive care unit (NICU). A nuchal cord was detected in 69 patients (34.2%). The incidence was not affected by parity or reduced amniotic fluid volume. There was no statistically significant increased risk for 1- and 5-min Apgar scores <7, umbilical artery pH <7.1, umbilical vein pH <7.20, umbilical artery base excess <-11, umbilical vein base excess <-11, perinatal death, cesarean section, ODFD or admission to NICU. Nuchal cord in post-term pregnancies is not associated with an increased risk for signs of fetal distress and operative intervention during labor and delivery.
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Affiliation(s)
- Gisela S Ghosh
- Department of Obstetrics and Gynecology, Malmö University Hospital, Malmö, Sweden
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Fleisch MC, Hoehn T. Intrauterine fetal death after multiple umbilical cord torsion-complication of a twin pregnancy following assisted reproduction. J Assist Reprod Genet 2008; 25:277-9. [PMID: 18581227 DOI: 10.1007/s10815-008-9227-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 05/02/2008] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients requiring assisted reproductive techniques may have a higher rate of congenital malformations. Some rare complications of pregnancy might be related to such abnormalities. Torsions of the umbilical cord resulting in fetal death have previously been described exclusively in pregnancies following spontaneous conception. CASE The case of 37 year old gravida I, para O woman with a twin pregnancy after intracytoplasmatic sperm injection and intrauterine death of one twin at approximately 30 weeks' gestation is presented. The surviving twin was delivered by cesarean section at 31 weeks after spontaneous onset of labor and recurrent fetal bradycardia. The intraoperative situs showed that the demised twin had suffered from multiple umbilical cord torsions leading to intrauterine hypoperfusion. CONCLUSION Umbilical torsion leading to fetal death might represent a previously unrecognized complication in women requiring assisted reproductive techniques, but this problem is known to occur in pregnancies achieved by natural methods.
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Affiliation(s)
- M C Fleisch
- Department of Obstetrics and Gynecology, Heinrich-Heine-University, Duesseldorf, Germany
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