ABSTRACT
Resumen Las anomalías del cordón umbilical están asociadas a efectos adversos durante el embarazo. El nudo verdadero del cordón umbilical está presente en el 0.3-2.1% de los embarazos y se ha asociado a muerte fetal. Dentro de los factores de riesgo se incluye, la edad materna, índice de masa corporal (IMC) elevado, multiparidad, trastornos hipertensivos, tabaquismo, polihidramnios, diabetes gestacional, sexo masculino del feto y otras malformaciones. El diagnóstico prenatal del nudo verdadero es raro y un desafío. La mayoría se diagnostica durante el nacimiento y sólo el 0.08% de los nudos verdaderos son diagnosticados de manera prenatal. El registro cardiotocográfico puede registrar trazos no tranquilizadores que reflejan que hay un estrés hipóxico o mecánico que interrumpe la oxigenación fetal. El objetivo de este reporte es mostrar un caso de nudo verdadero del cordón umbilical que presentó taquicardia fetal persistente durante el trabajo de parto con terminación del embarazo vía vaginal.
Abstract Umbilical cord abnormalities are associated with adverse effects during pregnancy. The true umbilical cord knot is present in 0.3-2.1% of pregnancies and has been associated with fetal death. Risk factors include maternal age, high BMI, multiparity, hypertensive disorders, smoking, polyhydramnios, gestational diabetes, male sex of the fetus, and other malformations. Prenatal diagnosis of the true knot is rare and challenging. Most are diagnosed at birth and only 0.08% of true knots are diagnosed prenatally. Non-reassuring cardiotocography traces may be present, reflecting hypoxic or mechanical stress disrupting fetal oxygenation. The aim of this case report is to present a case of true umbilical cord knot presenting with persistent fetal tachycardia during labor, resolved by vaginal delivery.
ABSTRACT
Background & Objective: Umbilical cord length and number of loops around fetal neck leadsto intrapartum complication which can predict by antenatal screening.This study was carried out to find the effect of length of umbilical cord on intrapartumcomplication, mode of delivery, perinatal outcome.Methods: This is a prospective study conducted at NHL MMC from August 2020 to July 2021.Total 300 cases were taken. Antenatal ultrasound carried out to screen nucle cord and afterdelivery number of loops were noticed and APGAR score noted.Results: Out of 300 cases 5 case were <35 cm and 2 cases >102 cm ,97 cases were 66-75cm.86% had medium cord length, 8.67% had long, 5.3% short cord length. 11.5% case with longcase had IUFD. 85.7% with 3 loops delivered by cesarean section.Conclusion: Increase umbilical cord length and loop associated with complication like fetalheart rate variation, fetal asphyxia, increase cesarean rate. Intrapartum fetal monitoring avoidsperinatal morbidity and mortality.
ABSTRACT
Background: Perinatal asphyxia may be caused by perinatal anemia. The pathophysiology and neurodevelopment effects are theoretically different from other causes of fetal asphyxia. Severe asphyxia can occur in infants around the time of birth by various reasons. The aim of this study to find the relationship between cord blood hemoglobin and perinatal asphyxia.Methods: This was a retrospective comparative study in department of OBG In tertiary care health centre. Umbilical cord blood samples were collected from 100 newborns with asphyxia at birth as study group and 100 newborns with non asphyxia as control group. Hemoglobin was measured colorimetrically.Results: This study finds that maximum number of patients in both the control and study group had hemoglobin in the range of 16.3-17.3 gm/dl. The difference was not statistically significant. P value>0.05.Conclusions: Hematological changes observed early after delivery can determine the duration of hypoxemia (acute versus chronic) Perinatal anemia causing moderate to severe perinatal asphyxia is associated with a higher risk for neonatal mortality. All survivors with perinatal anemia, however, showed no abnormalities in neurodevelopment in contrast to children who were born asphyxiated due to various another causes. The underlying pathophysiological mechanism for the favorable NDO in the perinatal anemia group needs further elucidation.
ABSTRACT
Objective: Our purpose was to evaluate the relationship between umbilical cord arterial blood lactate levels with acid base balance to the mode of delivery and short-term neonatal outcome in a large multiracial population delivering at term in University of Malaya Medical Centre. Materials and methods: Two thousand two hundred and twelve patients of more than 37 weeks of gestation with singleton, liveborn infants with no major anomalies delivering between January 2013 to December 2013 were analysed. Lactate was measured by using portable Lactate analyzer that requires 5 µml of blood and provides the result within 1 minute. The deliveries took place at the Department of Obstetrics and Gynaecology, University Malaya Medical Centre, Malaysia where umbilical cord blood sampling and blood gas analysis is a part of the routine assessment of all newborn. Results: Gestational age ranged from 37 to 43 weeks (mean 39.05 weeks). The highest mean arterial cord lactate values were noted among babies delivered instrumentally (4.87 mmol/L). Infants who had a normal vaginal delivery had the second highest levels (3.36 mmol/L), followed by infants delivered by emergency caesarean section (3.30mmol/L). The lowest lactate values were noted in deliveries by elective caesarean section (3.0mmol/L). Cord arterial lactate levels were significantly higher among infants born with low Apgar scores (7.02 mmol/L vs 4.6mmol/L, P < 0.001). High arterial cord lactate was a significant predictor of admission to Neonatal intensive care unit (NICU) was 6.0mmol/L. Receiver operator curve (ROC) analysis suggests that lactate and pH are virtually equivalent in their correlation with adverse neonatal outcome. Conclusion: Cord lactate levels are significantly related to the mode of delivery and is equivalent to cord arterial pH in predicting adverse neonatal outcomes, with similar efficacies; however, its simplicity, less sampling failure and low cost makes lactate analysis an interesting alternative in obstetric care.