Nuchal cord
Nuchal cord | |
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Birth asphyxia[1] | |
Treatment | Unwrapping the cord during delivery or if this is not possible clamping and cutting the cord[2] |
Prognosis | Usually good[1] |
Frequency | 25% of deliveries[2] |
A nuchal cord is when the
The diagnosis may be suspected if there is a decrease in the baby's heart rate during delivery.[1] Nuchal cords are typically checked for by running the finger over the baby's neck once the head has delivered.[4] Ultrasound may pick up the condition before labor.[1]
If detected during delivery, management includes trying to unwrap the cord or if this is not possible clamping and cutting the cord.[2] Delivery can typically take place as normal and outcomes are generally good.[5][1] Rarely long term brain damage or cerebral palsy may occur.[1][6] Nuchal cords occur in about a quarter of deliveries.[2] The condition has been described at least as early as 300 BC by Hippocrates.[1]
Signs and symptoms
Symptoms of a prior nuchal cord shortly after birth in the baby may include duskiness of face, facial
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Petechiae and subconjunctival bleeding due to tight nuchal cord
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Petechiae on face due to tight nuchal cord
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Facial duskiness due to tight nuchal cord
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Abrasion from a nuchal cord
Diagnosis
In 1962, J. Selwyn Crawford MD from the British Research Council defined a nuchal cord as one that is wrapped 360 degrees around the fetal neck. Crawford commented "It is all the more remarkable, therefore, that little work has been done. to analyze its effects during labor and delivery".[citation needed] To date, there is no prospective case control double-blind study looking at nuchal cords and observational studies vary in opinion as to the degree of poor outcomes. Also not included in these studies is which umbilical cord form (of the 8 different possible structures) was considered a nuchal cord.[citation needed]
Ultrasound diagnosis of a cord around the neck was first described in 1982.[7] “Coils occur in about 25% of cases and ordinarily do no harm, but occasionally they may be so tight that constriction of the umbilical vessels and consequent hypoxia result.”[citation needed] Williams Obstetrics 16th Edition, has only one single sentence in the entire textbook regarding cords around the neck.[8] By contrast, the First Edition of the Encyclopædia Britannica from 1770 had 20 pages of information about Umbilical Cord Pathology with drawings of Umbilical Cord Entanglement. The Royal College of Obstetricians and Gynaecologists has these images on its brochure. There are currently three recent texts on ultrasonography which demonstrate the ability of ultrasound to identify umbilical cord issues with reliability as of 2009.[citation needed]
A study published in 2004 was done to establish the sensitivity of ultrasound in the diagnosis of a nuchal cord. Each of 289 women, induced the same day, underwent a transabdominal
In no study was it possible by ultrasound to distinguish between a loose or a tight cord, although at least 3 attempted to do so.[
Classification
- A "Type A" nuchal cord is wrapped around the neck but is free sliding[1]
- A "Type B" pattern is described as a hitch which cannot be undone and ends up as a true knot.[11]
Treatment
Management of a presenting nuchal cord should be tailored to prevent umbilical cord compression whenever possible. Techniques to preserve an intact nuchal cord depend on how tightly the cord is wrapped around the infant's neck. If the cord is loose, it can easily be slipped over the infant's head. The infant can be delivered normally and placed on maternal abdomen as desired. If the cord is too tight to go over the infant's head, the provider may be able to slip it over the infant's shoulders and deliver the body through the cord. The cord can then be unwrapped from around the baby after birth. Finally, if the cord is too tight to slip back over the shoulders, one may use the somersault maneuver to allow the body to be delivered.[12] The birth attendant may also choose to clamp and cut the umbilical cord to allow for vaginal delivery if other methods of nuchal cord management are not feasible.
Prognosis
Retrospective data of over 182,000 births, with the statistical power to determine even mild associations, suggest that a single or multiple nuchal cords at the time of delivery is not associated with adverse perinatal outcomes, is associated with higher
References
- ^ PMID 29234502.
- ^ a b c d "Nuchal Cord". Merck Manuals Consumer Version. June 2018. Archived from the original on 9 April 2021. Retrieved 2 October 2018.
- PMID 19346188.
- ISBN 9780323084307.
- ISBN 978-1455733941.
- PMID 26003063.
- S2CID 5976372.
- ISBN 978-0838597316.
- ^ PMID 15543520.
- ^ Wilson B (March–April 2008). "Sonography of the Placenta And Umbilical Cord". Radiologic Technology. 79: 333S–345S. Retrieved December 26, 2017.
- PMID 11876571.
- PMID 10099799.
- S2CID 259999326.
- S2CID 33991885.
- S2CID 31359895.
- .