Does the nuchal cord persist? An ultrasound and color-Doppler-based prospective study

How to Reach the Best Ultrasound Performance in the Delivery Room

Ultrasonography is an instrument that is present in the maternal-fetal assessment throughout pregnancy and with widely documented benefits, but its use in intrapartum is becoming increasingly relevant. From the assessment of labor progression to the assessment of placental disorders, ultrasound can be used to correlate with physiological findings and physical examination, as its benefit in the delivery room cannot yet be proven. There are still few professionals with adequate training for its use in the delivery room and for the correct interpretation of data. Thus, this article aims to present a review of the entire applicability of ultrasound in the delivery room, considering the main stages of labor. There is still limited research in evidence-based medicine of its various possible uses in intrapartum, but it is expected that further studies can bring improvements in the quality of maternal and neonatal health during labor.

Umbilical cord characteristics and their association with adverse pregnancy outcomes: A systematic review and meta-analysis

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.

Influence of tension of the nuchal cord to the developmental output in a one-year-old child

Objective

Influence of nuchal umbilical cord tension in a newborn on the developmental outcome at the end of the first year.

Methods

and subjects of research: The research is prospective, conducted in northern Bosnia and Herzegovina (Una Sana Canton), for a period of five years. In the research study, we included newborns with a nuchal cord (tight and loose) and newborns without a nuchal cord (control group). We were tracking and recording the Apgar score and the conventional cardiotocography (CTG) findings in both groups. The development of newborns was monitored by the Munich Functional Scale and the development was evaluated at the end of the first year of life.

Results

Statistically, there was a significant presence (P < .001) of Apgar score lower than 7 in newborns with nuchal cord concerning the control group. There were significantly lower Apgar score findings in newborns with a tight nuchal cord compared to ones with a loose nuchal cord (P <.001). Pathological cardiotocographic findings were monitored and the statistical significance in neonates with a nuchal cord concerning the control group. Cardiotocographic data in a neonatal group with tight nuchal cord were statistically significantly lower concerning cardiotocographic data in neonates with a loose nuchal cord (P <.001). Infants at the age of 1 year born with tight nuchal cord were found to have a significant developmental delay compared to those born with loose nuchal cord and control group (P <.001).

Conclusion

The nuchal cord is the risk factor for later developmental deviation. Early diagnosis of the nuchal cord, especially tight cord around the neck (nuchal cord), is important for the prevention of later morbidity.