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Protocol for management of late second-trimester and term fetal death
Published in Minakshi Rohilla, Recurrent Pregnancy Loss and Adverse Natal Outcomes, 2020
Aruna Singh, Pradip Kumar Saha
Umbilical cord events: Umbilical cord events like nuchal cord, knots, or other abnormalities accounted for 10% of fetal deaths in one population-based study. Although cord abnormalities are common (occurring in 15%–34% of pregnancies at term) [16], they are rarely severe enough to cause fetal demise.
Assessment of Fetal Well-Being in Labor Fetal Heart Rate Patterns — Their Pathophysiology and Clinical Relevance
Published in Miriam Katz, Israel Meizner, Vaclav Insler, Fetal Well-Being, 2019
Miriam Katz, Israel Meizner, Vaclav Insler
Early decelerations may be seen in early stages of labor in patients with a nuchal cord.14 Most of these patients develop variable decelerations of FHR as labor progresses. The direct, bilateral pressure on the carotic bodies obviously has the same effect as the increased intracranial pressure on the vagal reflex, therefore effecting a similar change in the FHR.
Prenatal diagnosis of surgical conditions
Published in Prem Puri, Newborn Surgery, 2017
Ultrasound testing has become a routine part of the prenatal evaluation of almost all pregnancies. It is especially important to perform ultrasound for pregnancies with maternal risk factors (e.g., age over 35 years, diabetes, previous child with anatomic or chromosomal abnormality) and if there is an elevation in maternal serum alphafetoprotein (MSAFP). Most defects can be reliably diagnosed in the late first or early second trimester by a skilled sonographer. Early in gestation, nuchal translucency measurements are an independent marker of chromosomal abnormalities, with a sensitivity of about 60%.2 This abnormality may be detected on transvaginal ultrasound at 10–15 weeks gestation, thus providing an early test for high-risk pregnancies. Nuchal cord thickening may also be a marker for congenital heart disease3 and may be a valuable initial screen to detect high-risk fetuses for referral for fetal echocardiography. It is important to remember that sonography is operator-dependent; the scope and reliability of the information obtained are directly proportional to the skill and experience of the sonographer.
Medulloblastoma in a toddler with Gorlin syndrome
Published in Baylor University Medical Center Proceedings, 2018
Mohamad G. Al-Rahawan, Sorleen Trevino, Roy Jacob, Jeffrey C. Murray, Mohamad M. Al-Rahawan
A 16-month-old biracial male was hospitalized with progressive bilateral esotropia that was worse on the right. He also had loss of appetite, clumsiness, and imbalance with crawling. The patient started cruising without walking at 15 months of age but progressively digressed with onset of ataxia. His medical history included a nuchal cord during pregnancy, full-term delivery, and a brief stay in the neonatal intensive care unit at birth due to respiratory distress but without the requirement for intubation. He met all developmental milestones except for walking and had no notable cognitive impairment. Significant family history included a half brother with cerebral palsy, hydrocephalus, and a possible brain mass who died at 3 years of age.
Annular Indentation of the Ventricles in a Stillborn: A Case Report and Literature Review
Published in Fetal and Pediatric Pathology, 2022
Shima Rastegar, Amer Akmal, Debra S. Heller
A 45 year-old-woman, gravida 4 para 3 with an unremarkable prenatal course, delivered a stillborn male at 40 weeks of gestation. The fetus was well developed and appropriate for gestational age with no signs of hydrops fetalis. The autopsy revealed that the cause of the stillbirth was a cord accident with a tight nuchal cord wrapped twice around the neck. An incidental finding was a deep circumferential indentation around the lower part of the ventricles. The heart weighed 32.0 grams (expected for full-term: 18.6 ± 12.9 grams). Chambers and vascular leaflets were normal. No indentation was seen inside the cardiac chambers grossly and the pericardium, as well as the chest wall overlying the heart, were unremarkable.
Comparative study of umbilical cord cross-sectional area in foetuses with isolated single umbilical artery and normal umbilical artery
Published in Journal of Obstetrics and Gynaecology, 2022
Tian-Gang Li, Chong-Li Guan, Jian Wang, Mei-Juan Peng
The present study has several strengths. Post-natally, we confirmed the diagnosis of isolated SUAs in all newborn patients and followed their general conditions, including their birth weight, placental quality and umbilical blood vessel cross-sectional area measurements. One previous study determined the umbilical cord diameter (Raio et al. 1999) and other scholars used elliptic functions to measure the UA and UV (Cromi et al. 2005; Barbieri et al. 2012). However, considering that the cross-sectional shape of the UV and UA is generally not ideally round, we opted to manually draw the outline of the UA and UV to calculate the area automatically, as described by Togni, Araujo Júnior, et al. (2007), Togni, Araujo, et al. (2007). However, the present study also has some limitations. First, the nuchal cord can decrease the length of the umbilical cord and tighten it; the pressure around the neck and the umbilical cord further affects the changes in umbilical blood flow. In this study, we did not analyse or summarise the conditions of the umbilical cord around the neck. Second, when UA blood flow is determined, the measurement of the umbilical cord may differ from its dimensions at other times, resulting in variations in these measurements. In this study, we selected the free segment for measurement to minimise UA blood flow changes caused by squeezing of the umbilical cord by the foetal limb. Third, although this study found that isolated SUAs are closely associated with low-birth-weight infants, other confounding factors, including the lower prevalence of isolated SUA cases, may have resulted in intrauterine growth retardation in foetuses with isolated SUA. Therefore, further research and analysis are necessary to investigate the impact of these epidemiological factors.