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Eric Jauniaux - One of the best experts on this subject based on the ideXlab platform.
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ultrasound detection of Nuchal Cord prior to labor induction and the risk of cesarean section
Obstetrical & Gynecological Survey, 2005Co-Authors: E Peregrine, Patrick Obrien, Eric JauniauxAbstract:ABSTRACTThe term for an umbilical Cord that passes around the fetal neck is Nuchal Cord. Reported prevalence rates at delivery range from 6% to 37%. Up to half of Nuchal Cords resolve before delivery. Although the diagnosis is not routinely made before delivery, it may be suspected if there are vari
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ultrasound detection of Nuchal Cord prior to labor induction and the risk of cesarean section
Ultrasound in Obstetrics & Gynecology, 2005Co-Authors: E Peregrine, Patrick Obrien, Eric JauniauxAbstract:Objectives To investigate the ability of ultrasound to detect the presence of a Nuchal Cord immediately prior to induction of labor and the association of its presence with delivery by Cesarean section. Methods A transabdominal ultrasound scan using gray-scale and color Doppler imaging was performed immediately prior to induction of labor in 289 women in a prospective study to assess the presence of a Nuchal Cord. The presence of a Nuchal Cord was classified as present, absent or uncertain. The outcomes of labor, delivery and the neonates were obtained from the patient notes after delivery. Results A Nuchal Cord was present at 18% of deliveries. The incidence was not affected by parity, fetal position or reduced amniotic fluid volume. The sensitivity of ultrasound in diagnosing a Nuchal Cord was 37.5%, with specificity, positive and negative predictive values of 80%, 29% and 85%, respectively. The presence of a Nuchal Cord did not significantly increase the risk of delivery by Cesarean section (35% vs. 28%; relative risk = 1.22; 95% CI, 0.80–1.87), instrumental delivery for fetal distress, an abnormal cardiotocograph in labor or at delivery, an Apgar score < 7 at 1 min, arterial Cord pH < 7.1 or neonatal unit admission. Conclusions The sensitivity of the ultrasound diagnosis of a Nuchal Cord is low prior to induction of labor at term. A Nuchal Cord does not appear to increase the risk of Cesarean section or of poor neonatal outcome. The low ultrasound detection rate of a Nuchal Cord limits its use in decision making prior to induction of labor in high-risk pregnancies. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
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perinatal features of pregnancies complicated by Nuchal Cord
American Journal of Perinatology, 1995Co-Authors: Eric Jauniaux, Bruce A Ramsay, Claude Peellaerts, Yannik SchollerAbstract:The perinatal data of 550 fetuses with a Nuchal Cord at delivery were compared with those of a control group matched for gestational age, maternal age, and parity. The study group was subsequently subdivided into those fetuses with either single or multiple coils of Nuchal Cord. No significant differences were found in the comparison of routine ultrasound data between the two groups. The perinatal mortality rate and the prevalence of arterial pH less than 7.16, venous pH less than 7.20, and Apgar scores less than 7 at 5 and 10 minutes were similar in both groups. There was a significantly higher incidence of Apgar score less than 7 at 1 minute, meconium-stained amniotic fluid, emergency cesarean section, need for neonatal resuscitation, and of admission to the neonatal intensive care unit in the Nuchal Cord group compared with the controls. Multiple looping of the umbilical Cord around the fetal neck was the main factor accounting for the higher incidence of these complications and the only explanation put forward for the three perinatal deaths that occurred in this group, all of whom presented in the preceding week with decreased fetal movements. The results of the present study suggest that sonographic identification of Nuchal Cord may be an important observation during third trimester sonography, particularly when evaluating cases of decreased fetal movements.
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Nuchal Cord in normal third trimester pregnancy a color doppler imaging study
Ultrasound in Obstetrics & Gynecology, 1992Co-Authors: Eric Jauniaux, C Mawissa, C Peellaerts, Frederic RodeschAbstract:A prospective study was performed in a normal, unselected, population of 180 pregnant women to assess the screening properties of color Doppler imaging in the detection of Nuchal Cord during the third trimester of pregnancy. A search was made for the umbilical Cord position initially using conventional real‐time gray‐scale imaging and subsequently using color imaging. Umbilical artery resistance and pulsatility indices and maximum peak systolic velocity were measured in each case at the level of the placental Cord insertion. Forty‐five (25%) cases examined using color imaging presented with a Nuchal Cord at both ultrasound examination and delivery. Color imaging correctly identified in utero 28 (72%) single and 17 (94%) multiple Nuchal Cords found at birth. The overall sensitivity of color imaging in detecting Nuchal Cord prenatally was greater than for gray‐scale imaging (79% compared with 33%). The sensitivity of color imaging was also higher after 36 weeks than before (93% compared with 67%). No difference was observed between the umbilical artery resistance and pulsatility indices. There was also no difference observed for the maximum peak systolic velocity between cases presenting with a Nuchal Cord (at both ultrasound examination and delivery) and controls matched for gestational age. We suggest that the clinical usefulness of systematic identification in utero of Nuchal Cord in pregnancies presenting with a normal fetus in the vertex position is limited, but might be of value in the management of breech and twin gestations, and also in the management of chronically growth‐retarded fetuses. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Michael S Rogers - One of the best experts on this subject based on the ideXlab platform.
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relationship between umbilical Cord morphology and Nuchal Cord entanglement
Acta Obstetricia et Gynecologica Scandinavica, 2003Co-Authors: Michael S Rogers, Yun Qin, Sean M Rogers, Daljit Singh SahotaAbstract:Acta Obstet Gynecol Scand 2002; 82: 32-37. © Acta Obstet Gynecol Scand 2003 Objective. To determine whether tightening of Nuchal Cord entanglement is more likely to occur where normal Cord coiling is absent and there is deficient Wharton's jelly. The study was carried out in the delivery suite of a university teaching hospital, using a prospective matched controlled-pairs survey. Methods. Midwives identified index cases with Nuchal Cord entanglement at the time of delivery. The next delivery of equivalent gestation (± 1 week) without Cord entanglement was taken as the control. Only singleton pregnancies with cephalic presentation undergoing spontaneous labor were studied. Placental insertion, Nuchal entanglement (tight or loose), length, presence of knots, umbilical coiling index (UCI), and the amount of Wharton's jelly were reCorded. Results. Longer Cords were more frequent amongst male infants and were predisposed towards entanglement. There were no significant differences in the amount of Wharton's jel...
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color ultrasonography a useful technique in the identification of Nuchal Cord during labor
Ultrasound in Obstetrics & Gynecology, 2000Co-Authors: Y Qin, Chi Chiu Wang, Tze Kin Lau, Michael S RogersAbstract:Objective To compare the accuracy of intrapartum ultrasound with and without color Doppler for identification of Nuchal Cord displacement during labor. Methods 180 normal pregnant women, admitted in labor, or for induction to labor, were examined independently by two researchers, using either conventional real-time gray-scale imaging or color Doppler imaging. A repeat examination was performed by the other researcher using the other ultrasound modality. Nuchal Cord displacement was classified as either negative, definite or suspicious. Nuchal Cord at birth was classified as either tight or loose. Results Sixty-two (34%) cases examined using the two ultrasound imaging modalities presented with Nuchal Cord at delivery. The sensitivity of color Doppler was 96.8%. The accuracy of color Doppler in detecting Nuchal Cord during labor was significantly better (P < 0.05) than gray-scale imaging alone. The results of a restricted sequential t-test analysis of 53 un-tied pairs showed an overall preference in favor of color Doppler assessment: statistical significance (P <0.01) was reached after 41 un-tied pairs. Conclusions The tight and loose Nuchal Cord could not be distinguished by ultrasound. Color Doppler imaging can provide useful additional information to gray-scale imaging in the detection of Nuchal Cord displacement during labor. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
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lipid peroxidation in Cord blood the effects of umbilical Nuchal Cord
British Journal of Obstetrics and Gynaecology, 1997Co-Authors: Chi Chiu Wang, Michael S RogersAbstract:Objective To examine the relation between Cord entanglement around the fetal neck and umbilical arterial measures of free oxygen radical activity at birth. Design Prospective observational stuy of the lipid peroxide levels in umbilical Cord arterial blood. Setting Delivery suite of Prince of Wales Hospital, Hong Kong. Population Women with a singleton pregnancy, at term (37 to 42 weeks of gestation), cephalic presentation, spontaneous or induced labour and an initially normal fetal heart rate tracing. Methods A series of 230 singleton deliveries had determination of two lipoperoxides in umbilical arterial Cord blood: malondialdehyde and organic hydroperoxide. Umbilical pH, PO2, PCO2 and base excess were also measured in both umbilical Cord arterial and venous blood. Main outcome measures Umbilical Cord blood gases and arterial malondialdehyde and organic hydroperoxide levels. Results Forty-nine cases of Nuchal Cord were observed: 14 tight and 35 loose. Tight Nuchal Cord was associated with a low 1-min Apgar score and increased lipid peroxide levels. Loose Nuchal Cord was associated with larger amniotic fluid volume and significantly decreased lipid peroxide levels. Conclusions This study suggests that tight Nuchal Cord is associated with increased free oxygen radical activity in the fetus, but that loose Nuchal Cord carries no adverse effects.
Christian Marth - One of the best experts on this subject based on the ideXlab platform.
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impact of Nuchal Cord on measurement of fetal Nuchal translucency thickness
Ultrasound in Obstetrics & Gynecology, 2007Co-Authors: M Scheier, D Egle, I Himmel, Angela Ramoni, S Viertl, O Huter, Christian MarthAbstract:OBJECTIVE: To define the impact of Nuchal Cord on the measurement of fetal Nuchal translucency thickness (NT). METHODS: Between December 2004 and June 2006, we examined prospectively 53 fetuses that were observed on routine first-trimester ultrasound examination between 11 + 3 and 13 + 6 weeks of gestation to have Nuchal Cord causing an indentation in the skin in the Nuchal region. The fetuses were re-examined after a median interval of 132 min, when the Cord was no longer around the neck and indentation of the skin had resolved. Various NT measurements (highest, lowest, mean) with the Cord located around the neck (Nuchal Cord) were compared with NT measurements in the absence of Nuchal Cord ('true' NT) in the same fetuses. Measurements were considered to be equal when they were within mean +/- 1.96 SD, defined by our own intraobserver repeatability acCording to the method of Bland and Altman. RESULTS: The mean of the largest and the smallest of six measurements in the presence of Nuchal Cord fell within the mean +/- 1.96 SD of our own intraobserver repeatability, i.e. gave a correct estimate of the true NT, in 80% of fetuses, while the NT was overestimated in 10% and underestimated in 10% of fetuses. The largest and the smallest of six measurements in the presence of Nuchal Cord gave an underestimate of the true NT in 2% of fetuses and an overestimate in 4% of fetuses, respectively. CONCLUSION: There is a wide scattering of measurements in fetuses with Nuchal Cord in comparison to the same fetuses in the absence of Nuchal Cord. This prevents accurate prediction of the true NT, although the largest and smallest of repeat measurements with Nuchal Cord can allow calculation of the highest and lowest possible risks, respectively. These facts must be taken into consideration in counseling patients.
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impact of Nuchal Cord on measurement of fetal Nuchal translucency thickness
Ultrasound in Obstetrics & Gynecology, 2007Co-Authors: M Scheier, D Egle, I Himmel, Angela Ramoni, S Viertl, O Huter, Christian MarthAbstract:Objective To define the impact of Nuchal Cord on the measurement of fetal Nuchal translucency thickness (NT). Methods Between December 2004 and June 2006, we examined prospectively 53 fetuses that were observed on routine first-trimester ultrasound examination between 11 + 3 and 13 + 6 weeks of gestation to have Nuchal Cord causing an indentation in the skin in the Nuchal region. The fetuses were re-examined after a median interval of 132 min, when the Cord was no longer around the neck and indentation of the skin had resolved. Various NT measurements (highest, lowest, mean) with the Cord located around the neck (Nuchal Cord) were compared with NT measurements in the absence of Nuchal Cord (‘true’ NT) in the same fetuses. Measurements were considered to be equal when they were within mean ± 1.96 SD, defined by our own intraobserver repeatability acCording to the method of Bland and Altman. Results The mean of the largest and the smallest of six measurements in the presence of Nuchal Cord fell within the mean ± 1.96 SD of our own intraobserver repeatability, i.e. gave a correct estimate of the true NT, in 80% of fetuses, while the NT was overestimated in 10% and underestimated in 10% of fetuses. The largest and the smallest of six measurements in the presence of Nuchal Cord gave an underestimate of the true NT in 2% of fetuses and an overestimate in 4% of fetuses, respectively. Conclusion There is a wide scattering of measurements in fetuses with Nuchal Cord in comparison to the same fetuses in the absence of Nuchal Cord. This prevents accurate prediction of the true NT, although the largest and smallest of repeat measurements with Nuchal Cord can allow calculation of the highest and lowest possible risks, respectively. These facts must be taken into consideration in counseling patients. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.
Brian Peat - One of the best experts on this subject based on the ideXlab platform.
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outcomes of external cephalic version and breech presentation at term an audit of deliveries at a sydney tertiary obstetric hospital 1997 2004
Acta Obstetricia et Gynecologica Scandinavica, 2006Co-Authors: Natasha Nassar, Christine L Roberts, Carolyn A Cameron, Brian PeatAbstract:Background. Probabilistic information on outcomes of breech presentation is important for clinical decision-making. We aim to quantify adverse maternal and fetal outcomes of breech presentation at term. Methods. We conducted an audit of 1,070 women with a term, singleton breech presentation who were classified as eligible or ineligible for external cephalic version or diagnosed in labor at a tertiary obstetric hospital in Australia, 1997–2004. Maternal, delivery and perinatal outcomes were assessed and frequency of events quantified. Results. Five hundred and sixty (52%) women were eligible and 170 (16%) were ineligible for external cephalic version, 211 (20%) women were diagnosed in labor and 134 (12%) were unclassifiable. Seventy-one percent of eligible women had an external cephalic version, with a 39% success rate. Adverse outcomes of breech presentation at term were rare: immediate delivery for prelabor rupture of membranes (1.3%), Nuchal Cord (9.3%), Cord prolapse (0.4%), and fetal death (0.3%); and...
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systematic review of adverse outcomes of external cephalic version and persisting breech presentation at term
Paediatric and Perinatal Epidemiology, 2006Co-Authors: Natasha Nassar, Christine L Roberts, Alexandra Barratt, Jane C Bell, Emily C Olive, Brian PeatAbstract:Summary The aim of this study was to determine the frequency of adverse maternal and fetal outcomes of both external cephalic version (ECV) and persisting breech presentation at term. We conducted a systematic review of the literature using Medline, Embase and All Evidence Based Medicine (EBM) Reviews databases. Data were extracted from studies that compared women who had an ECV from 36 weeks’ gestation with a similar control group of women enrolled at the same gestational age, eligible for, but who did not have an ECV. Eleven studies with a total of 2503 women were included. Adverse outcomes related to ECV were rarely reported and in most studies there was no evidence that relevant outcomes were ascertained among similar women who did not have an ECV. There was no increased risk of antepartum fetal death associated with ECV, but numbers were small. There were no reported cases of uterine rupture, placental abruption, prelabour rupture of membranes or Cord prolapse, but these outcomes were not examined among controls. Onset of labour within 24 h and Nuchal Cord was non-significantly higher among women who had an ECV compared with those with a persisting breech. Despite limited reporting and small numbers, the results of our review suggest that adverse maternal and fetal outcomes of both ECV and persisting breech presentation are rare. Only with improved reporting and collection of safety data on ECV and persisting breech presentation can we provide high-quality information to assist informed decision making by pregnant women with a breech presentation at term.
David M Sherer - One of the best experts on this subject based on the ideXlab platform.
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current perspectives of prenatal sonographic diagnosis and clinical management challenges of Nuchal Cord s
International Journal of Women's Health, 2020Co-Authors: David M Sherer, Kayana Ward, Michelle Bennett, M DalloulAbstract: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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recurrent antepartum compression of a single artery double Nuchal Cord necessitating emergency cesarean delivery
American Journal of Perinatology, 2005Co-Authors: David M Sherer, Fady Khourycollado, Mudar Dalloul, Joseph A Osho, Madelene D Lamarque, Larissa Fomitcheva, Ovadia AbulafiaAbstract:Fetuses with a single umbilical artery are considered at increased risk for chromosomal and structural abnormalities, and increased adverse perinatal outcome. A young nulliparous patient was followed with weekly nonstress testing due to well-controlled gestational diabetes, a single umbilical artery, and a double Nuchal Cord. At 31 weeks gestation, following the occurrence of a severe prolonged variable deceleration of the fetal heart rate the patient was hospitalized for close fetal surveillance with consideration that the deceleration may represent recurring intermittent compression of the single umbilical artery. Continuous fetal monitoring depicted recurrent severe variable decelerations of the fetal heart rate. Thirty-six hours after admission, prolonged fetal bradycardia to 60 bpm necessitated emergency cesarean delivery of a nonhypoxic nonacidotic fetus, which subsequently did well. This case suggests that fetuses with a single umbilical artery Nuchal Cord(s) may be at increased risk of significant umbilical Cord compression.
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is fetal cerebral vascular resistance affected by the presence of Nuchal Cord s in the third trimester of pregnancy
Ultrasound in Obstetrics & Gynecology, 2005Co-Authors: David M Sherer, M Dalloul, M Sokolovski, F Khourycollado, Ovadia AbulafiaAbstract:Objective To assess whether fetal cerebral vascular resistance is affected by the presence of Nuchal Cord(s) in the third trimester. Methods A set of 115 patients with well-established dates and singleton, appropriate for gestational age (GA), nonanomalous fetuses with Nuchal Cord(s) diagnosed with prenatalcolorDopplerimaging,between28and41 weeks and 115 controls matched for GA, were studied. Patients with hypertension, diabetes and autoimmune conditions were excluded. Doppler indices were obtained from the umbilical artery (UA) and the fetal middle cerebral artery (MCA) upon initial diagnosis of the Nuchal Cord. Results Of 115 GA-matched pairs of pregnancies, 103 fetuses had a single Nuchal Cord and 12 a double Nuchal Cord. No significant differences were noted in patient age, gravidity, parity, sonographically estimated fetal weight (SEFW), and growth centile at ultrasonographic diagnosis. Mean UA systolic/diastolic ratio (S/D) was 2.28 ± 0.32 and 2.36 ± 0.33 (P = 0.03) and UA resistance index (RI) 0.55 ± 0.06 and 0.57 ± 0.06 (P = 0.02) among study and controls, respectively. Mean fetal MCA S/D and RI did not differ significantly between the two groups (fetal MCA S/D 5.01 ± 1.28 and 5.04 ± 1.71 (P = 0.86), and mean fetal MCA RI 0.78 ± 0.06 and 0.78 ± 0.05 (P = 0.88)). No significant differences were noted in GA at delivery, incidence of meconium-stained amniotic fluid, birth weight, mode of delivery, neonatal gender, 1 and 5 minute Apgar scores, or UA pH and base excess, between study and control patients. Conclusion Fetal cerebral vascular resistance is not affected by the presence of Nuchal Cord(s) in the third trimester of pregnancy. Copyright 2005 ISUOG. Published by John Wiley & Sons, Ltd.
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sonographic verification of a Nuchal Cord following a vibratory acoustic stimulation induced severe variable fetal heart rate deceleration with expedient abdominal delivery
American Journal of Perinatology, 1991Co-Authors: David M Sherer, Jacques S Abramowicz, Bobbi Hearnstebbins, James R WoodsAbstract:A case is presented in which external vibratory acoustic stimulation performed following a nonreactive nonstress test produced a severe variable deceleration of the fetal heart rate. A clinically suspected Nuchal Cord was confirmed by ultrasound. This rapid precise antepartum diagnosis of Cord compression prevented untimely delay and led to immediate abdominal delivery of a nonacidotic, yet hypoxic, infant. This report suggests care be taken when fetal vibratory acoustic stimulation is applied in cases of oligohydramnios and a known existing Nuchal Cord.
