Prenatal diagnosis of surgical conditions
Prem Puri in 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.
Abnormalities of Second Stage
Gowri Dorairajan in Management of Normal and High Risk Labour During Childbirth, 2022
When the second stage is confirmed, active vigilance should start for the descent of the head, fetal heart rate, and any features of cephalo-pelvic disproportion. Depending on the parity, up to half to 1 hour can be allowed for the passive descent of the head and spontaneous urge to push. We need to expedite vaginal delivery by encouraging active bearing down or by operative assistance in the following situations: Suspicious fetal heart rate, especially severe early deceleration and variable deceleration suggestive of nuchal cord. In women with pathological CTG pattern.The woman had been in a prolonged active phase of labour.High-risk conditions in women preclude prolonged bearing down such as hypertension, preeclampsia, and heart disease.For women with previous caesarean section, scars are more likely to disrupt in the second stage. Reducing the second stage duration will reduce the exposure of the scarred area to strong uterine contractions.More than 1 hour has passed, and there is no urge to push and in the absence of features suggestive of cephalopelvic disproportion.In women undergoing a trial of labour.
Assessment of Fetal Well-Being in Labor Fetal Heart Rate Patterns — Their Pathophysiology and Clinical Relevance
Miriam Katz, Israel Meizner, Vaclav Insler in Fetal Well-Being, 2019
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.
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.
The impact of nuchal cord on umbilical cord blood gas analysis and ischaemia-modified albumin levels in elective C-section
Published in Journal of Obstetrics and Gynaecology, 2018
Aslı Yarcı Gursoy, Burcin Ozgu, Yasemin Tasci, Tuba Candar, Salim Erkaya, Gamze Sinem Caglar
Although, the clinical significance of such a frequent clinical condition still needs to be elucidated, the presence of the nuchal cord in labour and delivery has been associated with adverse neonatal outcomes. The recent data indicate that nuchal cords during labour and a vaginal delivery may cause decreased foetal perfusion (Martin et al. 2005).
Impact of nuchal cord on antenatal and intrapartum foetal heart rate surveillance and perinatal outcome
Published in Journal of Obstetrics and Gynaecology, 2020
Salvatore Tagliaferri, Francesca Giovanna Esposito, Giuseppina Esposito, Gabriele Saccone, Maria Gabriella Signorini, Giovanni Magenes, Marta Campanile, Maurizio Guida, Fulvio Zullo
Nuchal cord (NC) is defined as the umbilical cord wrapped 360 degrees around the foetal neck at least once. It has an incidence ranging from 23 to 33% of all deliveries (Cunningham et al. 2010), but its clinical relevance is not entirely clear.
Related Knowledge Centers
- Anemia
- Childbirth
- Fetus
- Petechia
- Shortness of Breath
- Ultrasound
- Umbilical Cord
- Meconium
- Stillbirth
- Subconjunctival Bleeding
- Shortness of Breath