ABSTRACT
Umbilical cord is the connecting link between the foetus and the placenta through which foetal blood flows to and from the placenta. It extends from the foetal umbilicus to the foetal surface of the placenta. Excessively long cords are linked with cord entanglement. Nuchal cord occurs when umbilical cord gets wrapped around foetal neck 3600. Single loop around neck is reported in 20-34% cases. Cord compression is one of the postulated factors for birth asphyxia. It has become a cause of concern for rising primary C Section rate. We wanted to determine the actual threat nuchal cord poses to the mother as well as to the foetus and identify various factors which should be considered for safe delivery in these patients. METHODSThis study was conducted in the Department of Health and Medical Education, Sub-District Hospital, Akhnoor, J & K. We included 100 cases in the test group in which nuchal cord was identified during delivery, delivered either vaginally or by C section. These cases were compared with 100 controls delivered without nuchal cord. We had to observe 462 patients for finding out 100 cases. Incidence of nuchal cord in our study is 21.64%. Patients profile was noted on proforma and various variables were compared such as age, parity, gestational age, mode of delivery, duration of labour, length of cord, number of loops and prior USG detection of cord were noted in every case. Foetal outcome as observed in terms of gender, birth weight and Apgar score was recorded. RESULTSMost of the patients belonged to the age group 21-25 years with a mean age of 25.56 years. Incidence of nuchal cord is 21.64%. As the number of turns increased, incidence fell progressively, but as the number of loops increased length of cord also increased. Only 36 loops were pre detected on USG. Maximum number of patients had normal vaginal delivery in both groups, but the rate of C section was higher in test group and difference was statistically significant (0.028). When variables of newborn were compared, no significant difference was seen in sex and weight of the baby. Meconium stained liquor was more in nuchal cord group and although low Apgar score was more in nuchal cord group, the difference was not statistically significant. CONCLUSIONSNuchal cord is a common feature observed during delivery and is seen almost in 20-25% cases. Ante natal diagnosis of nuchal cord is possible with USG and colour doppler imaging. Elective C section for nuchal cord is a wrong practice. Patients should be assessed holistically including age, parity, gestational age, Bishop score and signs of foetal distress. Vigilant ante partum and intra partum monitoring is required in every case. Nuchal cord is potential cause of perinatal distress and rarely significant long-term neurodevelopmental consequences are seen in the foetus.
ABSTRACT
Background: This study was aimed at observing the outcomes of pregnancies with sonographically detected nuchal cord or cord around the neck at term. Early studies on nuchal cord showed many maternal and neonatal complications. But several recent studies have suggested that maternal and neonatal complications do not increase with nuchal cord at delivery. This ambiguity increases anxiety in treating obstetricians and relatives of pregnant women, thus leading to unnecessary caesarean sections. This study is intended to observe the maternal and neonatal outcomes of 300 pregnant women with sonographically detected nuchal cord at term.Methods: Prospective observational study where 300 term pregnant women with sonographically detected nuchal cord were observed through delivery at Shri Venkata Sai Medical College, Mahabubnagar, Telangana, during October 2016 to April 2018.Results: In this study 80.6% women had normal vaginal delivery, 8.3% had LSCS, 11% had instrumental deliveries. 54% had loose nuchal cord, 46% had tight loop of cord.60% had normal CTG, 8% had variable deceleration, 2% late deceleration. Neonatal morbidity was 9.6% and zero neonatal mortality.Conclusions: The study concluded that the presence of nuchal cord does not adversely affect the mother and the neonate. Presence of nuchal cord per se is not an indication for LSCS. Effect of nuchal cord on neonate is only transient. These women can be allowed for vaginal delivery with routine labour room protocols. Routine sonographycal detection of nuchal cord is not required and if it is reported, it should not dictate obstetric management.
ABSTRACT
Background: Umbilical cord around neck of the foetus is called the nuchal cord. The aims and objectives are to find out the incidence of nuchal cord around foetal neck at delivery, and to compare and evaluate intrapartum and postpartum maternal and foetal outcome in those with or without nuchal cord at delivery.Methods: It is a prospective cross-sectional study conducted at tertiary care hospital for period of 12 months. Of 1380 patients, 934 patients were enrolled in present study after meeting the inclusion and exclusion criteria of which 150 patients were included in study group who delivered with nuchal cord and 784 patients in control group who delivered without nuchal cord.Results: Present study showed 18.84% incidence of nuchal cord at delivery. Duration of labour was 6.51hrs in study group and 6.15hrs in control group and the difference was statistically significant. Rest of the intrapartum and postpartum events were statistically not significant. Mean length of cord was more in patients delivered with loop of cord around foetal neck as compared to another group and it is statistically significant.Conclusions: Nuchal cord is a common finding at the time of delivery. However, it is per-se not an indication of LSCS and it only increases the operative morbidity.
ABSTRACT
ObjectiveTo study the influences of fetal umbilical cord around neck on foetus、newborn infants and the choices of delivery mode during delivery.Methods220 cases of cephalic delivery pregnant women with fetus who had fetal umbilical cord around neck symptom and 220 cases of cephalic delivery pregnant women with fetus who didn't have fetal umbilical cord around neck symptom,were selected to make a contrast observation.ResultsThe foetus who had fetal umbilical cord around neck symptom had higher rate of fetal distress and neonatal asphyxia.The maternal cesarean section would be much higher,too.The rate is 18.5％,8.6％,49.6％ which were higher than the foetus who didn't have such kind of symptom,the rate is 5.4％,1.8 ％,26.4％ ( all P ＜ 0.05 ).The rate of fetal distress and neonatal asphyxia was proportional to the number of circles around neck.One circle around neck is 12.6％,1.4％ ;two circles around neck is 27.1％,17.0％ ;three and more than 3 circles around neck is 69.2％,53.8％.ConclusionWe should enhance perinatal B-mode ultrasonic examination and fetal monitoring circle around neck,pay close attention to the factor of umbilical cord around neck and select suitable delivery mode so that we can reduce the incidence of fetal distress and neonatal asphyxia.When B-mode ultrasonics displays that the number of the umbilical cord around the fetus' neck is three and more than 3 circles,the incidence of neonatal asphyxia is high and the cesarean section is the best choice under such circumstances.
ABSTRACT
Introducción: un supuesto incremento en el riesgo de resultados perinatales negativos en fetos expuestos a circular de cordón a cuello lleva con frecuencia a la realización de la operación cesárea, sin embargo, no es claro que la circular de cordón esté realmente asociada con la frecuencia de malos resultados fetales o neonatales. El objetivo del artículo es hacer una revisión de las publicaciones sobe el resultado perinatal asociado con la circular de cordón a cuello yla vía del parto que reviste mayor seguridad.Materiales y métodos: se realizó una búsqueda bibliográfica en las bases de datos electrónicas PubMed, Ovid, SciELO y LILACS, así como de revistas indexadas y sociedades médicas reconocidas: The American College of Obsteticians and Gynecologists, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, The American Journal of Obstetrics and Gynecology y the Medical Journal Armed Forces India.Resultados: se revisaron 520 títulos, de los cuales cumplían con nuestros criterios de selección 40 revisiones, correspondientes a diseños de tipo transversal, de cohorte, casos y controles, y revisones sistemáticas. Los estudios muestran que no se presentan diferencias significativas entre pacientes con y sin circular única de cordón respecto al retardo de crecimiento intrauterino (RCIU), disminución en el valor de Apgar al nacer o mortalidad perinatal como parámetros de evidencia de resultados adversos perinatales. Además, las tasas de cesáreas en pacientes con circular de cordón única están alrededor de un 9 por ciento frente a un 13 por ciento en pacientes sin circular.Conclusión: la evidencia disponible en la actualidad no soporta de manera consistente la asociación entre la presencia de circular de cordón fetal y resultados perinatales advesos mayores, al compararlos con fetos sin circular de cordón. Existe algún riesgo en situaciones especiales como las múltiples vueltas de cordón y la circular ajustada al cuello. No hay evidencia que soporte la realización de cesárea ante la presencia de circular única en nuca fetal...
Introduction: a supposed increase in the risk of poor perinatal results regarding fetuses having an umbilical cord that is wrapped around their necks (nuchal cord) often leads to a cesarean operation having to be performed; however, it is not clear whether a nuchal cord is really associated with the frequency of poor fetal or neonatal results. This article has been aimed at reviewing publications about perinatal results associated with a nuchal cord and the safest birth route. Materials and methods: a bibliographic search was made of PubMed, Ovid, SciELO and LILACS databases, as well as indexed journals and recognized medical societies: The American College of Obstetricians and Gynecologists, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, The American Journal of Obstetrics and Gynecology and the Medical Journal Armed Forces India. Results: 40 of the 520 titles reviewed complied with our selection criteria; they dealt with crosssectional, cohort, case and control and systematictype reviews. The studies showed that there were no significant differences between patients having or without a single-loop nuchal cord regarding intrauterine growth retardation (IUGR), reduced Apgar score at birth or perinatal mortality as parameters showing adverse perinatal results. The rates of cesareans in patients having single-loop nuchal cord were around 9% compared to 13% in patients where this had not occurred. Conclusion: currently available evidence did not consistently support an association between the presence of nuchal cord and greater adverse perinatal results when compared to fetuses without nuchal cord. There is some risk in special situations such as multiple cord loops and wrapping of the cord around the neck. No evidence was found supporting carrying out a cesarean section regarding the presence of a single loop nuchal cord...
Subject(s)
Female , Pregnancy , Ultrasonics , Umbilical CordABSTRACT
Type B ultrasonic scanning was performed routinely for 10 944 pregnant women at their third semester when they visited outpatient department or were admitted to our hospital during January 2004 to December 2008, and their fetal heart rate, amniotic fluid, umbilical cord and neonate conditions were monitored and recorded during delivery. The sensitivity and specificity of type B ultrasonic were 95.74% (3301/3448) and 96. 25 % (7215/7496). Umbilical abnormality was diagnosed in 3448 pregnancies by type B ultrasonic scanning, with prevalence of 31.51%, cesarean section was performed in 44.00 %, fetal distress occurred in 18. 27% of them, 15.46% of them with Apgar score equal to or less than seven, and fetal death occurred in 2. 41% of them, all significantly higher than those in pregnant women without umbilical abnormal (23. 77%, 8. 56%, 7.84% and 1.36%, respectively, all P ＜0. 01 ). Cesarean section was performed in 41.90 % of those with 0. 8 cm or more in the notch depth of nuchal cord entanglement,fetal distress occurred in 29.76% of them, 25.30% of them with Apgar score equal to or less than seven and fetal death occurred in 4. 05% of them, all significantly higher than those in pregnant women with the notch depth less than 0. 8 cm (20. 22%, 8. 60%, 9. 26% and 0. 54%, respectively, all P ＜0. 01 ). Type B ultrasonic scanning plays an important role in clinical diagnosis for umbilical abnormality, guiding selection of delivery method and improving neonatal prognosis.