Loop Of Cord Research Articles

Prospective Observational Study Of The Outcome Of Pregnancies With Sonologically Detected Nuchal Cord At Term

Background: Nuchal cord refers to the condition where the umbilical cord wraps around the fetal neck, potentially leading to complications during pregnancy and delivery. The prevalence of nuchal cords at delivery ranges between 6% and 37%, with possible adverse outcomes including fetal asphyxia, hypoxia, and in severe cases, stillbirth. The current study aims to evaluate the impact of nuchal cord detection via ultrasound in fullterm pregnancies and assess its prognostic significance concerning perinatal outcomes. Materials and Methods: This prospective observational study involved a cohort of pregnant women at term (37- 42 weeks of gestation) with sonologically detected nuchal cords. Ultrasound evaluations were conducted to determine the presence and characteristics of nuchal cords, including the number of loops and tightness. The outcomes measured included the mode of delivery, fetal distress, Apgar scores, and neonatal complications such as hypoxic-ischemic encephalopathy (HIE) and meconium aspiration syndrome (MAS). Statistical analysis was performed to assess the correlation between nuchal cord characteristics and perinatal outcomes. Results: The study found that the presence of nuchal cords was associated with an increased rate of cesarean deliveries and a higher incidence of fetal distress during labor. However, the degree of tightness and the number of loops significantly influenced the severity of outcomes. Neonates with tightly looped nuchal cords showed a higher incidence of low Apgar scores and required more intensive neonatal care. The study also observed a slight increase in the occurrence of neonatal complications, including MAS and HIE, among those with multiple nuchal cord loops. Conclusion: The detection of nuchal cords at term via ultrasound is a valuable tool in predicting potential delivery complications. While many nuchal cords do not adversely affect perinatal outcomes, those with multiple loops or tight cords pose a higher risk of complications. This study emphasizes the importance of careful monitoring and tailored management strategies for pregnancies complicated by nuchal cords to optimize maternal and fetal outcomes.

Umbilical Artery Doppler and Adverse Outcomes in Severe Preeclampsia Without Fetal Growth Restriction: A Retrospective Cohort Study.

Background and objective Severe preeclampsia may be managed expectantly before 34 weeks gestation with close surveillance.Utilized in fetal growth restriction (FGR), evidence supports umbilical artery (UA) Dopplerpreventing neonatal morbidity from hypertensive disease and predicting adverse outcomes in preeclampsia. We evaluated the association of abnormal UA Doppler waveforms with early delivery (before 34 weeks gestation) and adverse maternal-fetal outcomes in patients with early severe preeclampsia without FGR. Methodology This is a retrospective cohort study of singleton pregnancies with International Classification of Diseases (ICD) Ninth or Tenth Revision, defined severe preeclampsia diagnosed before 34 weeks gestation without FGR from January 1, 2018, through January 27, 2023, at a large tertiary care center where S/D ratios were calculated from UA Doppler interrogation of a free loop of cord at least once weekly. This study was approved by the IRB (ID:00002216) and granted a full Health Insurance Portability and Accountability Act (HIPAA) waiver of consent. Exclusion criteria were major congenital anomalies, congenital infection, aneuploidy, leaving against medical advice >24 hours, and patient instability on admission defined as condition(s) precluding expectant management by the American College of Obstetrics and Gynecology. The primary outcome was delivery before 34 weeks gestation. Secondary outcomes were the mode of delivery and maternal/fetal complications. Patient characteristics and outcomes for normal versus abnormal UA Doppler groups were compared with chi-square, t-tests, and Fisher's exact test. Odds ratios and relative risks were calculated to compare outcomes. Results Of 194 patients with severe preeclampsia, 107 met inclusion criteria. Thirty-four patients had abnormal UA Doppler studies. There were no differences in demographic and clinical data between patients with normal and abnormal UA Doppler studies. Patients with abnormal UA Doppler studies were more likely to deliver before 34 weeks (OR=3.91; 95%CI 1.24-12.33) for worsening severe features (OR=3.85; 95% CI 1.42-10.41), and were less likely to deliver vaginally (OR=0.12; 95% CI 0.03-0.54). Abnormal UA Doppler studies were associatedwith an increased risk of neonatal complications (OR=6.46; 95% CI 1.42-29.42) and respiratory distress syndrome (RDS) (OR=4.75; 95%CI 1.32-17.16). Abnormal UA Doppler subgroups were divided into patients with elevated S/D >95% Acharya (N=22) and absent end-diastolic flow (EDF) (N=10). The elevated S/D group tended to deliver before 34 weeks gestation for worsening severe features (OR=3.71, 95% CI 1.144-12.050) and had a higher risk of neonatal complications (RR 1.404; 95% CI 1.213-1.624). The absent EDF subgroup was more likely to deliver before 34 weeks (RR=1.52; 95%CI 1.29-1.79) for abnormal fetal testing (OR=6.92; 95%CI 1.71-28.08) and undergo primary cesarean delivery (OR=7.23; 95%CI 1.43-36.61). Conclusion Pregnancies with severe preeclampsia without FGR displayed a high incidence of abnormal UA Doppler waveforms associated with loss of clinical stability and adverse fetal outcomes. The groups with more impedance to umbilical artery flow tended to deliver earlier, and as the Doppler shifted from elevated S/D to absent end-diastolic flow, the mode of delivery shifted to cesarean delivery with increased risk of abnormal fetal testing. These results support the utility of UA Doppler surveillance in severe preeclampsia.

True Umbilical Cord Knot without Adverse Perinatal Outcome: A Brief Review

True umbilical cord knots are not a common occurrence, however when they do present, it is ironic that despite having availability of antenatal ultrasound, they are not diagnosed antenatally most of the time, due to cord length and loops of cord making visibility poor. However with 4 dimension ultrasound and serial doppler study there can be better pick up rate. There is controversy around risks with true knots and cases of meconium stained liquor, low Apgar scores, hypoxic ischemic encephalopathy, other neonatal complications necessitating neonatal intensive care unit admission and fetal still birth have been reported. The umbilical cord attaches to the placenta and transfers blood, oxygen and nutrition to the fetus. A true umbilical cord knot happens when the cord loops over itself with fetal movements, a tight knot can impair the fetal circulation and lead to fetal hypoxia. In such a situation, fetal surveillance shows sub optimal cardiotocograph tracing, and when the patient is taken for emergency cesarian section, a tight umbilical cord knot is seen, which was causing fetal hypoxia. Certain conditions are more predisposed for true knots such as polyhydramnios, longer length of the cord, smaller than average size fetus, monoamniotic twins and multiparity. Our case report presents a true umbilical cord at an elective cesarian section in a primigravida. The patient had an uneventful pregnancy with regular fetal surveillance through ultrasound and doppler scans and fetal heart tracing. An elective cesarian section was performed at 38 weeks at patient’s request and at the time a nuchal cord and true umbilical cord was noted.

Complex umbilical cord entanglement: A case report

Background: Complex umbilical cord entanglement occurs less frequently and is associated with an increased risk of adverse perinatal outcomes. It is associated with umbilical artery pH and base excess levels that are significantly unfavorable, higher incidence of nonreassuring fetal heart rate, meconium-stained amniotic fluid, neonatal intensive care unit admissions, emergency cesarean section, and stillbirth. Case presentation: A 44-year-old para 2+0 gravida 3, with 2 previous cesarean delivery scars at 35 weeks presented with a history of reduced fetal movements for 24 hours. She had attended two antenatal care visits. Her blood group was A, rhesus negative, with hemoglobin levels of 11.2 g/dl, and normal platelets. Urinalysis and serology for HIV, hepatitis B, and Venereal Disease Research Laboratory test were nonreactive. She had received anti-D prophylaxis after her previous deliveries. An urgent obstetric ultrasound scan showed features consistent with intrauterine fetal death. Her coagulation profile was within the normal range. She was admitted for hysterotomy. Intraoperatively, a fresh stillborn baby boy was extracted with a cord around the neck tightly twice and entangled around the trunk. Conclusion: Complex umbilical cord entanglement occurs less frequently and associated with an increased risk of adverse perinatal outcomes. The risk of adverse perinatal outcomes increases with ≥3 loops of the umbilical cord. It is important to look out for cord entanglement antenatally by ultrasonography, particularly when assessing cases of decreased fetal movements.

Activation of 5-HT5A receptor in the ventrolateral orbital cortex produces antinociceptive effects in rat models of neuropathic and inflammatory pain

The ventrolateral orbital cortex (VLO) is identified as an integral component of the endogenous analgesic system comprising a spinal cord - thalamic nucleus submedius - VLO - periaqueductal gray (PAG) - spinal cord loop. The present study investigates the effects of 5-HT5A receptor activation in the VLO on allodynia induced by spared nerve injury and formalin-evoked flinching behavior and spinal c-Fos expression in male SD rats, and further examines whether GABAergic modulation is involved in the effects evoked by VLO 5-HT5A receptor activation. We found an upregulation of 5-HT5A receptor expression in the VLO during neuropathic and inflammatory pain states. Microinjection of the non-selective 5-HT5A receptor agonist 5-CT into the VLO dose dependently alleviated allodynia, and flinching behavior and spinal c-Fos expression, which were blocked by the selective 5-HT5A receptor antagonist SB-699551. Moreover, application of the GABAA receptor antagonist bicuculline in the VLO augmented the analgesic effects induced by 5-CT in neuropathic and inflammatory pain states, whereas the GABAA receptor agonist muscimol attenuated these analgesic effects. Additionally, the 5-HT5A receptors were found to be colocalized with GABAergic neurons in the VLO. These results provide new evidence for the involvement of central 5-HT5A receptors in the VLO in modulation of neuropathic and inflammatory pain and support the hypothesis that activation of 5-HT5A receptors may inhibit the inhibitory effect of GABAergic interneurons on output neurons projecting to the PAG (GABAergic disinhibitory mechanisms), consequently activating the brainstem descending inhibitory system that depresses nociceptive transmission at the spinal cord level.

The effect of umbilical cord loops around the fetal neck on the modified Doppler myocardial performance index (Mod- MPI) in a sample of Egyptian population.

The effect of umbilical cord loops around the fetal neck on the modified Doppler myocardial performance index (Mod- MPI) in a sample of Egyptian population.

Management of Oligohydramnios with the Help of Ksheerapaka and Yashtimadhu Siddha Matrabasti: A Case Report

Amniotic fluid protects the baby and helps develop its limb, lung, digestive system, and muscle volume. The volume of amniotic fluid should increase as the pregnancy progresses. Roughly 4% of pregnant women are diagnosed with oligohydramnios. It occurs when the volume of fluid in the amniotic sac is lower than average, usually because the placenta is not functioning properly. It is a very serious complication of pregnancy associated with poor perinatal outcome. An effective treatment for oligo is very needful to grow fetus normally and delivered with no complication. In Ayurveda, oligohydramnios can be compared with Upavishtaka, Nagodara, and Garbhashaya condition in which Garbhaspandana and Anunnatkukshita mentioned by Acharaya Sushtra which is due to reduce of liquor. The present case report of primigravida with period of gestation by last menstruation period is 30 weeks 2 days with foetal movement with no history of labour pain, leaking and bleeding per vaginal. On ultrasound significant that single live uterine foetus with cephalic presentation with 30 weeks with resistance in left uterine artery, FHR – 128 bpm, placenta – anterior, grade 2, AFI – 6.7 cm, two loop of cord seen around neck Estimate weight – 1531 ± 327 kg, BPP- 6/8. The patient was treated by Ksheerapaka of Yashtimadhu, Bala, Ashwagandha, and Yashtimadhu Siddha Matrabasti. This case report revealed that oligohydramnios can be managed by Ayurvedic drug intervention

Outcome of Primigravida with Unengaged Fetal Head at Term or Onset of Labour

Objective: To investigate the duration and course of labour, the need for intervention and feto-maternal outcome in a primigravida with an unengaged fetal head at term in labour.
 Study Design: Prospective longitudinal study.
 Place and Duration of Study: Department of Obstetrics and Gynaecology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jun 2018 to Oct 2019.
 Methodology: This study was carried out on 150 term primigravida women with an unengaged head in labour. Informed consent, detailed history and examination were made along with ultra-sonographic and pelvic assessment.
 Results: Deflexed head was a frequent cause 49(32.67%), cephalopelvic disproportion 24(16%), and loop of cord around theneck 8(5.34%), however, no cause was found 54(36%) women with unengaged fetal head. Ninety three patients (62%)continued with spontaneous labour, while the rest had to be induced. Vaginal deliveries were 100(66.67%), while 50(33.34%) were delivered via Lower Segment Caesarean Section. Out of the 57patients who received induction of labour, 25(43.86%) had vaginal deliveries, while 32(56.14%) underwent Lower Segment Caesarean Section. Five (3.34%) went into a postpartum haemorrhage. Grade 3 perineal tears were seen in 3(2%) patients, and one had a wound infection. APGAR score at ten minutes was between 7 and at ten minutes in 115(76.67%) neonates.
 Conclusion: In primigravida at the onset of labour with an unengaged fetal head at term gestation, vaginal delivery is possible with watchful expectancy and appropriate intervention. However, there is a need to ensure that all inductions are strongly indicated.

Umbilical venous diameter and flow in monochorionic diamniotic twin pregnancy: association with placental sharing and fetal demise.

To examine the association of umbilical venous diameter and flow in monochorionic diamniotic twin pregnancy with placental sharing and fetal demise. This was a prospective longitudinal cohort study of a consecutive series of monochorionic diamniotic twin pregnancies that underwent ultrasound assessments at 12, 16, 20 and 28 weeks' gestation. Fetal biometry (crown-rump length at 12 weeks or estimated fetal weight (EFW) thereafter) and cord insertion sites were recorded at each visit, as well as the diameter of the umbilical vein (UV) in both the intra-abdominal part and a free loop of the umbilical cord. Time-averaged maximum velocity in the intra-abdominal part of the UV was measured to calculate UV-flow. Univariate and multivariate linear regression analyses were performed to assess the relationship between intertwin ratios of these variables and placental sharing at 12, 16, 20 and 28 weeks' gestation. Placental sharing was calculated by dividing the larger by the smaller placental share, as measured on placental injection studies after birth. Additionally, the Mann-Whitney U-test and receiver-operating-characteristics-curve analysis were used to explore the relationship between the occurrence of fetal demise and intertwin differences in fetal biometry, cord insertion sites, UV diameters and flow at 12, 16, 20 and 28 weeks. Of 200 consecutive monochorionic twin pregnancies enrolled, injection studies were performed in 165 (82.5%) placentas. On univariate analysis, intertwin differences in fetal biometry, cord insertions and UV variables were associated significantly with placental sharing at 12, 16, 20 and 28 weeks' gestation. On multivariate analysis, intertwin differences in fetal biometry, cord insertions and all three UV variables remained associated significantly with placental sharing at 12 and 16 weeks. However, at 20 and 28 weeks, only the intertwin EFW ratio was associated consistently with placental sharing. Fetal demise of one or both twins complicated 26 (13.0%) pregnancies. Differences in EFW and cord insertion sites were not associated significantly with fetal demise, while at 16 weeks, differences in intra-abdominal UV diameter and flow were associated with an increased risk of subsequent fetal demise. At 12 and 16 weeks' gestation, intertwin differences in UV diameter and flow reflect placental sharing more accurately than do differences in fetal growth and cord insertion sites. At 16 weeks, discordance in intra-abdominal UV diameter and flow is also associated with an increased risk of fetal demise. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Neonatal Outcome and Mode of Delivery with Nuchal Cord - A Cross Sectional Study

Aim: To determine the incidence of umbilical cord around the fetal neck and its effects on fetal outcome. Study Design: It is single center cross sectional study. Duration: The duration of study is two year from January 2020 to January 2021. Settings: This study was carried out in Independent University Hospital Faisalabad. Methodology: All patients presents after 28 weeks upto 41 weeks of gestation either delivered by caesarean section or delivered vaginal birth with baby having one, two or three loops of cord around the neck were selected. Fetal outcome was observed, maternal age, Parity, Gestational age, Mode of delivery, APGAR score and admission to NICU were noted. Results: A total of 102 patients (27.4%) were delivered having nuchal cord 65 patients (63.7%) were in age group (26-30y) and 60 patients (58%) were multipara delivered with cord around the neck of fetus. In present study cesarean section rate was 70.5%. In 25 patients (24.5%) nuchal cord was diagnosed before delivery and in 77 patients (75.4%) nuchal cord was incidental findings during labour. Regarding fetal outcome; In 47 babies (46%) delivered with nuchal cord were having APGAR score less than 5 but in 55 babies (53.9%) having good APGAR score. Conclusion: Nuchal cord is common incidental finding during labour and fetal outcome regarding APGAR score & NICU admission was better in patients delivered with nuchal cord. But the cesarean section rate was higher. Keywords: Nuchal cord, Frequency, Fetal outcome

FETO-MATERNAL OUTCOME OF ANTE-NATAL CARE PATIENTS WITH CORD AROUND THE NECK FINDING IN TERM PREGNANCY

Umbilical cord may sometimes surround the fetal neck, often detected during routine ultrasonography or delivery. The cord around neckmay untwines spontaneously, however, the continued presence of cord loops around neck affects the fetal outcome. Objectives: To study the incidence of cord around the neck finding (nuchal cord)and feto-maternal outcome. Methodology: The retrospective study was conducted at a tertiary care hospital of Central India. During the study period of 18 months, out of 1672deliveries, 470 deliveries had nuchal cord. The relevant data was extracted from the hospital records. Results: At the time of delivery, nuchal cord incidence was 28.1%. Out of 470 deliveries, 273 underwent LSCS with fetal distress possibly due to oligohydramnios as their prime indication. Low birth weight was seen among 26.8% newborns. 8.7 % newborns were admitted in NICU. However, no perinatal mortality was reported. Conclusion: Presence of nuchal cord at the time of delivery is quite common. One must rely on clinical skills for pre-delivery diagnosis of nuchal cord, especially in rural and peri-urban areas,where last-trimester USG reports are not available. The nuchal cord when accompanied by oligohydramniosdoes interfereduringlabour, and the outcome of delivery with respect to fetal distress.

A modified device to place abomasal infusion lines for rumen-cannulated cattle

A previously developed abomasal infusion device was modified for easy and successful placement of infusion lines into the abomasum of dairy cows. Similar to the original device, the modified device consists of 2 pieces: an insertion tool and a delivery tool. Updates include streamlining both the insertion and delivery tools by slightly altering dimensions and design, then smoothing all rough edges. The primary changes include a parallel cut along the entire length of the insertion and delivery tools and encasement of the infusion line inside both tools, allowing for smoother insertion through the reticulum-omasum orifice and into the omasum and abomasum. Additionally, increasing the outside diameter of the delivery tool to reduce the gap between the delivery tool and insertion tool, increasing the length of the tools, and making a loop of cord attached to the insertion tool facilitate insertion and easy ejection of the flange into the abomasum. By using this modified device, placement of abomasal infusion lines (including flange) was more successful.

Doppler velocimetry discordance between paired umbilical artery vessels and clinical implications in fetal growth restriction

Studies revealing a discrepancy in umbilical artery Dopplers between the two umbilical arteries in normally-grown fetuses necessitates further evaluation of the paired umbilical arteries in the setting of fetal growth restriction as this is a critical component in the surveillance of this population. Umbilical artery Doppler sampling in fetal growth restriction is typically assessed in 1 umbilical artery in a free loop of cord. Although discrepancies of >20% between the 2 umbilical arteries occur in 1 of 3 normal pregnancies, this has not been assessed in fetal growth restriction. Our objectives were to determine the frequency of discordant Doppler pulsatility indices between paired umbilical arteries in a fetal growth restriction cohort and to determine if sampling of 1 or both arteries alters surveillance or timing of delivery. A cohort of 425 growth-restricted fetuses between 25 and 39 weeks of gestation had umbilical artery Doppler pulsatility indices determined from both umbilical arteries in a midsegment of the cord to determine: (1) the discrepancy percentage between paired umbilical artery pulsatility indices and (2) the frequency of both arteries being normal, abnormal, or discordant (pulsatility index < and >95th percentile). To determine what sampling method increased the detection of an abnormal Doppler index, 3 sampling methods were compared: (1) average pulsatility index from both umbilical arteries, (2) pulsatility index from 1 umbilical artery chosen randomly, and (3) highest pulsatility index of the 2 umbilical arteries. The mean percentage difference between umbilical artery pulsatility indices was 11.7%, and in 15.8% of cases, it exceeded 20%. Both umbilical artery pulsatility indices were normal in 71.1% (302/425), abnormal in 12.2% (52/425), and discordant in 16.7% (71/425) of cases (P<.0001). Of the 3 sampling methods, the pulsatility index was abnormal in: (1) 19.2% (82/425) of cases when averaged from both umbilical arteries, (2) 22.1% (94/425) of caseswhen choosing 1 umbilical artery at random, and (3) 28.9% (123/425) of cases when the highest umbilical artery pulsatility index was used (P=.003). In this large fetal growth restriction cohort, the overall discrepancy between the 2 umbilical artery pulsatility indices was 11.7%. Among fetuses with at least 1 abnormal umbilical artery pulsatility index, 71 of 123 (57.7%) had 1 normal pulsatility index and 1 abnormal. Thus, the number of arteries sampled and the sampling method used may alter clinical decision-making, including frequency of surveillance and timing of delivery.

True umbilical cord knot and tight nuchal cord loops as a cause of fetal distress and emergent cesarean delivery: A Case report

True umbilical cord knot and tight nuchal cord loops as a cause of fetal distress and emergent cesarean delivery: A Case report

Management of IUGR with Pregnancy induced hypertension by Ayurveda Regimen: A Case Report

A Christain women aged 29 yrs visited OPD of NIA demmed to be university on (24/04/2021) with the complaint of Amenorhoea 9 months (G2P1A0L1) associated with itching on upper and lower extremities since 3 month. She also complaints of swelling in her leg, which resembles us towards the pedal edema. She also complaints of severe hyperacidity, chest pain on and off, occasional headache since 10 days in the first visit. Her L.M.P.-15/08/2020, E.D.D: 22/05/21 and P.O.G.-35 weeks 6 days. Diagnostic assessment was done by USG and Laboratory investigations and Clinical examination. The findings of USG revealed Single live intrauterine pregnancy of 34 weeks 6 days with mild IUGR, mild oligohydramnios. Loop of cord around neck, Normal fetoplacental blood flow pattern. Placenta was Grade III With calcified. In Ayurvedic classics lakshanas of Garbhakshaya, Garbhasosha, Vatabhipanna Garbha are near to signs and symptoms of IUGR. Ksheera vasti was planned along with it oral medications Avipatikar Churna, Pittantak Churna , Kapardika Bhasma, Shankha Bhasma and Gokshura Churna in combination, Phalasarpi, Swarna Vasanta malati rasa and Punarnavastak Kwatha. Patient got relief from Severe oedema. The other complaints like severe hyperacidity, Headache were relieved. Then after her B.P. was 110/70 throughout. Fetal movements were good after Vasti procedure due to which patient felt well relaxed. Patient got her labor pain and delivered on 8th May with the weight 2.2kg male child at Government Hospital. The delivery was uneventful. After ksheeravasti there was increase in weight of the baby around 118gms. Just in six days Vasti provided such a enormous change.&#x0D; Keywords: IUGR, Pregnancy Induced hypertension, Ksheera Vasti, Punarnavastak kwatha, Gokshura Churna

True Umbilical Cord Knot Leading to Fetal Distress – an Obstetric Emergency

Background: Umbilical cord true knot is a rare condition which affects about 1% of all pregnancies. Though the incidence is lower, it often goes undetected in antenatal period despite the availability of prenatal sonography and may lead to a compromised fetal outcome as presented in this case. In this case the presence of true knot of umbilical cord was missed despite routine sonography done just 1 week prior to delivery, when patient presented to casualty with complains of decreased fetal movements since 24 hours. This modality is said to be associated with adverse fetal outcome such as birth asphyxia or in adverse cases intra uterine fetal demise. Risk factors include long cord, polyhydramnios, small sized fetus, etc.&#x0D; Case Summary: 27 years old gravida two, para two, with 1 live issue with k/c/o hypothyroidism with previous lesions came with complaints of decreased fetal movement since 24 hours at 36 weeks 3 days of gestational period. The patient recorded regular ANC checkups and routine investigations within normal limits. Her USG scan done at 34.2 wks showing single loop of cord around neck and normal doppler findings. On examination her vitals were normal .Her abdominal examination showed uterus of 34 wks size, longitudinal lie, cephalic presentation and irritable with mild contractions present with scar tenderness . Her FHS were present/irregular/112 bpm with less variability. On p/v examination os was admitting tip of finger, cervix soft, 25% effaced, station high up, presenting part vertex, membrane present. She was advised admission and a cardio-tocography (CTG) was done which showed recurrent deep atypical variable decelerations with decreased beat to beat variability. An emergent cesarean section was taken. Newborn was a female diagnosed with true umbilical cord knot, 2 cm away from fetal insertion with cord length of 84 cm. The baby was shifted to NICU in view of respiratory distress.&#x0D; Conclusion: Despite of modern day ultrasonography and Doppler studies, true umbilical cord knot still remains a lesser diagnosed entity and so every pregnant patients should be monitored carefully with a watch for daily fetal movement count (DFMC)and weekly non stress test (NST) for fetal well being.

Cesarean Audit for fetal distress- A indispensable tool to reduce Obstetrician Distress

Background and Objectives: Overuse of cesarean section and its implications are of growing concern. Suspected fetal distress has been the commonest indication for cesarean in last few decades heart rate changes shown by fetus without being adversely affected and CTG has been criticized to create unnecessary higher rate of operative deliveries. There is need to know which fetal heart rate abnormality is important and leading to two adverse neonatal outcome to decrease unnecessary operative deliveries. Therefore Caesarean Audit was planned. Material and methods: A total of hundred women were included who underwent emergency cesarean section for suspected fetal distress in labour or without labour detected by cardiotocography or intermittent auscultation were included for analysis. Details were noted in pre designated proforma. Results: During the audit period, total number of caesarean done due to fetal distress analysed during the period were 100.The most common fetal heart rate abnormality was nonspecific in form of single or transient deceleration seen in 63% of cases where records were also incomplete, it was followed by persistent deceleration on cardiotocography which was present in 16% of the cases. In 57 women who were primigravida 14 (24%) patients had nonspecific fetal heart rate patterns and intra operative findings were normal in this group. These were avoidable cesareans. Various Intraoperative findings, observed ,maximum no. of cases had meconium stained liquor seen in 63% of the cases followed by abruption in 9 cases followed by other findings like loop of cord around the neck of foetus, thin scar or scar dehiscence . Maternal resuscitation was carried out only in 53% of cases. Detection delivery interval of less than 30 minutes was present in 4% of cases. In fetal outcomes 16% of babies diagnosed with fetal distress, had poor outcome where Apgar score &lt; 7 and 12 babies had asphyxia related NICU admission. 82% of babies had absolutely normal fetal outcome among which majority (78%) did not require any form resuscitation. which were thus avoidable cases. Conclusions: Correct Knowledge about Standardized fetal heart rate interpretations on CTG and there standardized management protocols like Maternal resuscitative measures ,follow up to ensure fast detection delivery interval should be practiced strictly in all cases of non reassuring Fetal Heart rate patterns. There should be consistent efforts in reducing the rate of cesarean sections particularly primary cesarean deliveries and in order to understand the degree to which cesarean delivery is preventable it is important to know no why cesareans are being performed. Therefore caesarean audit is need of the hour

Diagnostic Utility of Color Doppler Ultrasound for Nuchal CordDetection at Term: A Prospective Study

AbstractBackground: Nuchal cords are very common, with prev-alence rates ranging from 18% to 25%. Color Doppler sonog-raphy is a noninvasive method that can be used for nuchalcord diagnosis.Aim of Study: In this study, we investigated the diagnosticaccuracy of color Doppler ultrasound (US) in the detectionof nuchal cord among full term pregnant women.Material and Methods: We conducted a prospective studyon 250 full term pregnant women, who were examined bytwo-dimensional US and color Doppler US to detect nuchalcord presence. Only women with cephalic presentation andsonographicaly detected nuchal cord were included.Results: The mean age of studied group was 26.86±5.53years and the mean parity was 1.59±1.21. The mean gestational age was 38.24±1.218 weeks and the estimated fetal weight was 3.236±0.378Kg. Overall, the two-dimensional US detected 64% of the nuchal cord loops; while the color Doppler US detected 100% of the loops. Besides, the frequency of loops of cord around the neck detected after delivery was 94%; which was one loop in 83% of the cases. Accuracy of 2D US in detecting cord around the neck was 61.2%, while that of color Doppler is 94%.Conclusions: In conclusion, the accuracy of detecting thenuchal cord is more with color Doppler US than two-dimensional US.

792 Intrauterine transfusion practice patterns among members of the society for Maternal-Fetal medicine

To describe practice pattern among providers of intrauterine transfusion (IUT). In this cross-sectional study, maternal-fetal medicine specialists (MFM) were surveyed regarding their IUT practices. The survey was made available to members of the Society for Maternal-Fetal Medicine (SMFM) via posting on the SMFM website and via distribution through the SMFM Special Delivery email list. IUT survey questions included number performed annually, location of procedure, perioperative medications, maternal analgesia, fetal access site, and postoperative care. Data were reported using descriptive statistics. A total of 51 respondents completed the survey. The majority (75%) reported an institutional rate of fewer than 10 IUT per year. The majority (81%) responded that fewer than 5 MFM perform IUT at their institution. While most IUT occur in the operating room (78% viable and 49% previable), previable cases were more likely to occur elsewhere when compared to viable cases (34% vs 14% in Labor/Delivery room; 17% vs 7% in ultrasound suite). There were a variety of responses regarding perioperative use of tocolytics, antibiotics, paralytics, and steroids (Figure 1). Of the 41 who provided information about immediate postoperative care, most reported a minimal fetal monitoring period of a few hours after the procedure, with only 9 (22%) reporting universal admission for extended overnight monitoring. The most commonly reported fetal access site was the placental cord insertion (PCI), followed by a free loop of cord (Figure 2). There appears to be a wide range of IUT-specific practices among IUT-performing members of SMFM. Consideration should be given to convening an expert panel to review the available evidence and provide a list of best practices for IUT. Additional topics to address include frequency of ultrasound monitoring following first IUT, threshold for repeating IUT, and latest gestational age to perform IUT. Querying blood bank personnel regarding IUT-specific preparation of blood products should be another focus of future research.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of Complex Umbilical Cord Entanglement.

Diagnosis of potential umbilical cord compromise, namely, true knots of the umbilical cord and nuchal cords has been enabled with increasing accuracy with current enhanced prenatal sonography. Often an incidental finding at delivery, the incidence of true knots of the umbilical cord has been estimated at between 0.04% and 3% of deliveries. This condition has been reported to account for a 4 to 10-fold increase of stillbirth and perinatal morbidity of 11% of cases. Nuchal cords, commonly observed at the delivery of uncompromised, non-hypoxic non-acidotic newborns occur more frequently with single nuchal cords noted in between 20% and 35% of all deliveries at term. Multiple nuchal cords are considerably less frequent, with decreasing frequencies inverse to the number of nuchal cord loops. While clearly single (and likely double) nuchal cords are almost uniformly associated with favorable neonatal outcomes, emerging data suggest that cases of ≥3 loops of nuchal cords are more likely to be associated with an increased risk of adverse perinatal outcome (either stillbirth or compromised neonatal condition at delivery). We define cases of a true knot of the umbilical cord, cases of ≥3 loops of nuchal cords, any combination of a true knot and nuchal cord, or any umbilical cord entanglement (nuchal or true knot) in the presence of a single umbilical artery, in singleton gestations as complex umbilical cord entanglement. Two concurrent developments, the increase in accuracy of prenatal sonographic diagnosis of complex umbilical cord entanglement and recent data confirming fatal compromise of the umbilical circulation in approximately 20% of cases of stillbirth, suggest that establishing governing body guidelines for reporting of potential umbilical cord compromise, and recommendation of consideration for early-term delivery of select cases, may be warranted. This commentary will address current perspectives of prenatal diagnosis and clinical management challenges of complex umbilical cord entanglement.