Dilemmas In The Management Of Nuchal Cord

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Dilemmas In The Management Of Nuchal Cord

  1. 1. Dilemmas in the management of nuchal cord<br />Amita Suneja<br />Professor<br />UCMS & GTBH<br />
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  4. 4. Dilemmas<br />
  5. 5. Nuchal cord & Asphyxia<br />
  6. 6. Diagnosis of nuchal cord<br />Nuchal cord- 360 degree around the neck<br />Ultrasonic diagnosis in Antenatal period<br />2D USG / Doppler / 3D USG<br />Diagnostic criteria<br />Diagnostic accuracy : 35% - 80%<br />Can diagnose multiple loops: 2%(two loops) & 0.2% (&gt; 2loops)<br />CAN NOT differentiate between tight & loose cord<br />
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  8. 8. Behaviour of nuchal cord during ANP<br />Nuchal Cords appear & disappear <br />Rare before 20 weeks<br />Incidence increases as gestation increases<br />
  9. 9. Whether or not nuchal cords are associated with significantly increased adverse fetal outcome ? <br /> Monoamniotic twins<br />
  10. 10. Retrospective studies<br />
  11. 11. Prospective cross sectional studies<br />KUMJ 2006<br /><ul><li> 512 deliveries
  12. 12. 18% single loop, 3% multiple loops
  13. 13. Abn FHR, MSL, instrumental delivery ↑ in nuchal group but not significant
  14. 14. LSCS were more in non nuchal gp
  15. 15. Apgar <7 at 1’ was more in nuchal gp but at 5’ was not different</li></ul>NOT associated with adverse Perinatal outcome<br />
  16. 16. Prospective double blind studies<br />Eur J Obstet Gynecol Repr Biol 2005<br />352, Vx, SLF, 37-39 weeks<br />USG 38 weeks<br />Sens & spec: 85 & 89%<br />NOT associated with abnormal intra partum CTG / clinically significant Apgar score<br />Nullipara with nuchal cord had higher incidence of LSCS (18%)<br />Obstet Gynecol 2005<br />289 women<br />USG just before induction<br />Sens: 37%<br />No significant ↑ risk of LSCS (35 Vs 28%, RR- 1.22; 95% CI0.08-1.8), ID for AFD, Abn FHR, Apgar &lt; 7 at 1’, UBA pH &lt; 7.1 or NICU admissions<br />
  17. 17. Nuchal cord & feal acidosis<br />
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  19. 19. Can nuchal cord be cause of still birth?<br />Int J Obstet Gynecol 2000: 98 SB (84 AP + 14 IP)<br />Nuchal cord (single or multiple) is insufficient evidence to explain <br />Do complete work up of SB<br />Autopsy<br />HPE of UC & placenta<br />
  20. 20. Summary<br />
  21. 21. Food for thought<br />
  22. 22. THANK YOU<br />

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