ABSTRACT
La gestación gemelar monocorial monoamniótica presenta alto riesgo de muerte fetal en relación a complicaciones generales de las gestaciones gemelares así como específicas de la monoamniocidad, siendo la más grave la muerte fetal por entrecruzamiento de cordones, el cual se presenta en prácticamente la totalidad de los casos. En el manejo de la gestación monocorial monoamniótica es fundamental un correcto diagnóstico precoz ecográfico, así como un manejo y vigilancia estricta para detectar signos de entrecruzamiento de cordones que permitan evitar la progresión a muerte fetal intraútero. La necesidad de hospitalización y el momento de finalización de la gestación siguen generando controversia en la literatura médica (AU)
Monochorial monoamniotic twins are at high risk of fetal death due to the general complications seen in multiple gestations, as well as those specific to this type of pregnancy. The most severe complication in these pregnancies is fetal death due to cord entanglement, which occurs in almost all cases. Early ultrasonographic diagnosis and intensive prenatal surveillance are essential for the early detection of cord entanglement and the prevention of fetal death. The need for in-hospital management and the exact gestational age for delivery continue to generate controversy in the literature (AU)
Subject(s)
Humans , Female , Pregnancy , Adult , Nuchal Cord/complications , Nuchal Cord/diagnosis , Nuchal Cord/surgery , Pregnancy Complications/diagnosis , Pregnancy Complications/surgery , Fetal Mortality/trends , Nuchal Cord/mortality , Nuchal Cord/physiopathology , Indicators of Morbidity and Mortality , Fetal Death/prevention & control , Fetal Death/physiopathologyABSTRACT
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.
