Dilemmas In The Management Of Nuchal Cord
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This document discusses dilemmas in managing nuchal cord during delivery. It can be diagnosed prenatally using ultrasound, though accuracy is limited. Studies have found that nuchal cord: 1) May appear and disappear during pregnancy as gestation increases; 2) Is not consistently associated with adverse fetal outcomes like low Apgar scores, though some studies found higher C-section and instrumented delivery rates; and 3) Is insufficient on its own to explain stillbirths given incomplete understanding of its impacts and need to fully investigate other potential causes. The document raises questions about nuchal cord and asphyxia risk but notes more research is needed.
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2) After 6 hours of induced labor, abnormal fetal heart rate patterns appeared. A cesarean delivery was performed and a healthy baby was born with 8 tight nuchal cord loops.
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The document provides guidelines from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) for performing routine mid-trimester fetal ultrasound scans between 18-22 weeks of pregnancy. It recommends that all pregnant women should be offered the scan to detect fetal anomalies and complications. The scan should assess fetal growth and anatomy, and be performed by an individual with specialized training using standardized ultrasound equipment and documentation. While many malformations can be identified, some may be missed even with best practices.
Sonography of fetal GIT
A systematic approach to address the challenges faced in the examination and prenatal diagnosis of fetal GIT anomalies
Level II usg
Level II ultrasound aims to assess fetal anatomy and identify structural abnormalities. It involves a detailed scan of the fetal head, chest, abdomen, and limbs between 18-22 weeks. Key steps include measuring fetal biometry, examining the brain, heart, kidneys, and bones. Abnormalities like organ defects, skeletal dysplasias, and soft markers for genetic conditions are evaluated. Advanced techniques like 3D and 4D ultrasound help depict facial anomalies and aid diagnosis. A thorough Level II scan provides crucial information about fetal well-being and development.
Cardiotocography
Cardiotocography (CTG) is a technique used to monitor the fetal heart rate and uterine contractions during pregnancy using an electronic fetal monitor. It involves using two transducers, one to measure the fetal heart rate and another to measure uterine contractions. The monitor provides data on the baseline fetal heart rate, variability, presence of accelerations or decelerations associated with contractions. Abnormal patterns in these readings can indicate fetal hypoxia or stress requiring delivery.
Antenatal doppler
This document discusses color Doppler ultrasound techniques for fetal surveillance. It describes the anatomy of fetal and placental circulation and examines the uterine, umbilical and middle cerebral arteries. Waveform analysis using indices like S/D ratio, resistance index and pulsatility index is discussed. Normal and abnormal Doppler findings are presented along with their clinical significance and management. Precise techniques for imaging and interpreting various fetal blood vessels are provided.
Assessment of fetal wellbeing in pregnancy and labour jaipur
This document provides recommendations for antepartum and intrapartum fetal monitoring techniques. It discusses various techniques for antepartum surveillance including fetal movement counting, non-stress tests, biophysical profiles, and Doppler assessments of the uterine and umbilical arteries. It notes that while electronic fetal monitoring (EFM) is commonly used in labor, there is no evidence it improves outcomes compared to intermittent auscultation and it is associated with higher rates of intervention. The document provides 14 recommendations for various fetal monitoring techniques addressing their appropriate use, interpretation, and management responses.
Electronic fetal monitoring. ppt
The document provides an overview of electronic fetal monitoring, including:
1. It defines the objectives of explaining fetal heart rate patterns using standard terminology and identifying normal and abnormal patterns on fetal heart rate tracings.
2. It reviews elements of the fetal heart rate tracing like baseline rate, variability, accelerations, and decelerations using standard definitions from NICHD.
3. It provides examples of fetal heart rate tracings and asks the reader to interpret them using the described terminology.
Amnion & Umbilical Cord (General Embryology)
The amnion is a membrane that encloses the amniotic cavity and develops from amnioblast cells at 8 days of pregnancy. It separates from the cytotrophoblasts by 12 days. During the 4th week, expansion of the amniotic cavity leads to folding of the embryonic disc. By the 3rd month, the amnion comes into contact with the chorion. The amnion surrounds the fetus and forms a sheath around the umbilical cord by the end of the 3rd month.
Cardiotocography (CTG)
The document provides definitions and descriptions of key terms used in cardiotocography (CTG) including:
- Baseline heart rate, acceleration, deceleration, variability
- Reactive, bradycardia, tachycardia traces
- Decreased variability, sinusoidal patterns
- Early, late, variable decelerations
- Prolonged deceleration
- Suspicious/equivocal and pathological/ominous CTG traces
Clinical scenarios are presented involving pregnant women in labor with varying cervical dilation and fetal heart rate patterns on CTG monitoring. Uterine hyperstimulation is also defined.
Antenatal fetal surveillance
This document discusses antepartum fetal assessment. It begins by defining antepartum fetal surveillance as the assessment of fetal well-being before labor onset. The goals are early detection of at-risk fetuses to allow timely management and avoiding unnecessary interventions. It then lists various maternal, fetal, and pregnancy conditions that warrant fetal surveillance. The document goes on to describe multiple methods of antepartum assessment including ultrasound, non-stress tests, biophysical profiles, and Doppler studies. It provides details on interpreting and acting on the results of these tests to monitor fetal health and determine need for delivery.
CTG
This document provides guidance on interpreting cardiotocography (CTG) readings during labor and delivery. It discusses how to prepare for and perform CTG monitoring, including setting up the machine, positioning the patient, and differentiating the maternal and fetal heart rates. It then describes how to interpret various features of the CTG tracing such as the baseline fetal heart rate, variability, accelerations, decelerations, and overall patterns. Recommendations are provided on the actions to take based on whether the CTG reading is normal, suspicious, or pathological.
Management of normal labour
This document provides information on the management of normal labor. It defines labor and delivery and outlines the cardinal movements of labor. It discusses assessing and monitoring labor through the stages including fetal wellbeing, maternal wellbeing, and labor progress using a partogram. It covers managing each stage of labor including the first stage of dilation, the second stage of delivery, and the third stage of delivery of the placenta. Key points like positioning, pushing techniques, and care of the newborn are summarized.
Umbilical Cord (General Embryology)
The document discusses the morphology, development, and abnormalities of the umbilical cord. It begins by describing the umbilical cord's typical length, diameter, shape, and contents. It then explains the development of the primitive, then definitive umbilical cord. The document concludes by listing some abnormalities that can occur, such as short or long cords, umbilical hernias, or abnormal attachments.
Assessment of fetal wellbeing
Majority of fetal deaths occur in the antepartum period.
There is progressive decline in maternal deaths all over the world. Currently more interest is focused to evaluate the fetal health. The primary objective of antenatal assessment is to avoid fetal death.
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Assessment of fetal wellbeing in pregnancy and labour jaipur
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- Twin-twin transfusion syndrome occurs in 25% of monochorionic twins and can have high mortality rates if severe. Fetoscopic laser ablation has better outcomes than serial amnioreduction.
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Dilemmas In The Management Of Nuchal Cord
- 1. Dilemmas in the management of nuchal cord Amita Suneja Professor UCMS & GTBH
- 4. Dilemmas
- 5. Nuchal cord & Asphyxia
- 6. Diagnosis of nuchal cord Nuchal cord- 360 degree around the neck Ultrasonic diagnosis in Antenatal period 2D USG / Doppler / 3D USG Diagnostic criteria Diagnostic accuracy : 35% - 80% Can diagnose multiple loops: 2%(two loops) & 0.2% (> 2loops) CAN NOT differentiate between tight & loose cord
- 8. Behaviour of nuchal cord during ANP Nuchal Cords appear & disappear Rare before 20 weeks Incidence increases as gestation increases
- 9. Whether or not nuchal cords are associated with significantly increased adverse fetal outcome ? Monoamniotic twins
- 15. Apgar <7 at 1’ was more in nuchal gp but at 5’ was not differentNOT associated with adverse Perinatal outcome
- 16. Prospective double blind studies Eur J Obstet Gynecol Repr Biol 2005 352, Vx, SLF, 37-39 weeks USG 38 weeks Sens & spec: 85 & 89% NOT associated with abnormal intra partum CTG / clinically significant Apgar score Nullipara with nuchal cord had higher incidence of LSCS (18%) Obstet Gynecol 2005 289 women USG just before induction Sens: 37% No significant ↑ risk of LSCS (35 Vs 28%, RR- 1.22; 95% CI0.08-1.8), ID for AFD, Abn FHR, Apgar < 7 at 1’, UBA pH < 7.1 or NICU admissions
- 17. Nuchal cord & feal acidosis
- 19. Can nuchal cord be cause of still birth? Int J Obstet Gynecol 2000: 98 SB (84 AP + 14 IP) Nuchal cord (single or multiple) is insufficient evidence to explain Do complete work up of SB Autopsy HPE of UC & placenta
- 20. Summary
- 21. Food for thought
- 22. THANK YOU