Tight Nuchal Cord Research Articles

Prevalence of birth injuries and associated factors among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021. Crossectional study.

Birth injury is harm that a baby suffers during the entire birth process. It includes both birth asphyxia and birth trauma. In Ethiopia, birth injury has become the leading cause of neonatal morbidity and mortality, accounting around 28%-31.6% of neonatal mortality. The study aimed to assess the prevalence and factors associated with birth injuries among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021. Institution based cross-sectional study was conducted from February 15th to April 20th, 2021 in selected public hospitals of Addis Ababa, Ethiopia. Random sampling and systematic random sampling were used. Data was entered by using Epi data version 4.0.2 and exported in to SPSS Software version 25 for analysis. Both bivariate and multivariable logistic regressions analyses were used. Finally P-value <0.05 was used to claim statistically significant. The prevalence of birth injury was 24.7%. In the final model, birth asphyxia was significantly associated with the short height of the mothers (AOR = 10.7, 95% CI: 3.59-32.4), intrapartal fetal distress (AOR = 4.74, 95% CI: 1.81-12.4), cord prolapse (AOR = 7.7. 95% CI: 1.45-34.0), tight nuchal cord (AOR = 9.2. 95% CI: 4.9-35.3), birth attended by residents (AOR = 0.19, 95% CI: 0.05-0.68), male sex (AOR = 3.84, 95% CI: 1.30-11.3) and low birth weight (AOR = 5.28, 95% CI: 1.58-17.6). Whereas, birth trauma was significantly associated with gestational diabetic mellitus (AOR = 5.01, 95% CI: 1.38-18.1), prolonged duration of labor (AOR = 3.74, 95% CI: 1.52-9.20), instrumental delivery (AOR = 10.6, 95% CI: 3.45-32.7) and night time birth (AOR = 4.82, 95% CI: 1.84-12.6). The prevalence of birth injury among newborns has continued to increases and become life-threatening issue in the delivery and neonatal intensive care unit in the study area. Therefore, considering the prevailing factors, robust effort has to be made to optimize the quality obstetric care and follow up and emergency obstetrics team has to be strengthened to reduce the prevalence of birth injury.

Role of Volume Replacement during Neonatal Resuscitation in the Delivery Room.

Volume expanders are indicated in the delivery room when an asphyxiated neonate is not responding to the steps of neonatal resuscitation and has signs of shock or a history of acute blood loss. Fetal blood loss (e.g., feto-maternal hemorrhage) may contribute to perinatal asphyxia. Cord compression or a tight nuchal cord can selectively occlude a thin-walled umbilical vein, resulting in feto-placental transfusion and neonatal hypovolemia. For severe bradycardia or cardiac arrest secondary to fetal blood loss, Neonatal Resuscitation Program (NRP) recommends intravenous volume expanders (crystalloids such as normal saline or packed red blood cells) infused over 5 to 10 min. Failure to recognize hypovolemia and subsequent delay in volume replacement may result in unsuccessful resuscitation due to lack of adequate cardiac preload. However, excess volume load in the presence of myocardial dysfunction from hypoxic–ischemic injury may precipitate pulmonary edema and intraventricular hemorrhage (especially in preterm infants). Emergent circumstances and ethical concerns preclude the performance of prospective clinical studies evaluating volume replacement during neonatal resuscitation. Translational studies, observational data from registries and clinical trials are needed to investigate and understand the role of volume replacement in the delivery room in term and preterm neonates. This article is a narrative review of the causes and consequences of acute fetal blood loss and available evidence on volume replacement during neonatal resuscitation of asphyxiated neonates.

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

Influence of tension of the nuchal cord to the developmental output in a one-year-old child.

ObjectiveInfluence of nuchal umbilical cord tension in a newborn on the developmental outcome at the end of the first year.Methodsand subjects of research: The research is prospective, conducted in northern Bosnia and Herzegovina (Una Sana Canton), for a period of five years. In the research study, we included newborns with a nuchal cord (tight and loose) and newborns without a nuchal cord (control group). We were tracking and recording the Apgar score and the conventional cardiotocography (CTG) findings in both groups. The development of newborns was monitored by the Munich Functional Scale and the development was evaluated at the end of the first year of life.ResultsStatistically, there was a significant presence (P< .001) of Apgar score lower than 7 in newborns with nuchal cord concerning the control group. There were significantly lower Apgar score findings in newborns with a tight nuchal cord compared to ones with a loose nuchal cord (P<.001). Pathological cardiotocographic findings were monitored and the statistical significance in neonates with a nuchal cord concerning the control group. Cardiotocographic data in a neonatal group with tight nuchal cord were statistically significantly lower concerning cardiotocographic data in neonates with a loose nuchal cord (P<.001). Infants at the age of 1 year born with tight nuchal cord were found to have a significant developmental delay compared to those born with loose nuchal cord and control group (P<.001).ConclusionThe nuchal cord is the risk factor for later developmental deviation. Early diagnosis of the nuchal cord, especially tight cord around the neck (nuchal cord), is important for the prevention of later morbidity.

Favorable outcome after nine minutes of shoulder dystocia preceded by a tight nuchal cord

Abstract Objectives A case report involving a tight nuchal cord and concomitant shoulder dystocia with a review of the literature. We demonstrate that favorable outcomes may result with correct application of maneuvers and adequate management after delivery. Case presentation A 41 years old woman was admitted with spontaneous rupture of membranes. The first stage of labor was unremarkable. During the second stage, an intentionally-cut tight nuchal cord was followed by 9 min of shoulder dystocia that was finally relieved by delivery of the anterior shoulder. APGAR scores were 0, 3, 4, 7 at 1, 5, 10 and 20 min respectively. The neonate was placed under therapuetic hypothermia and was discharged after 13 days. At 5 months and 1.5 years of age, the infant met age appropriate developmental milestones with no neurologic sequela. Conclusions Shoulder dystocia can result in fatal outcomes for the neonate. Adequate management highlights the need for prompt recognition of this complication and application of appropriate maneuvers. Therapeutic hypothermia decreases mortality and improves neurological development in infants who experience hypoxic ischemic encephalopathy (HIE).

Nuchal Cord and Perinatal Outcome at the Yaounde General Hospital, Cameroon

The aim of this study was to determine the incidence of nuchal cord at delivery and perinatal outcome. We conducted a retrospective descriptive study from 1992–2008 at the Yaounde General Hospital. Obstetrical and neonatal variables were compared in the loose and tight nuchal cord groups and a control group (no nuchal cord). Of 9275 deliveries recorded, 16.2% had a nuchal cord. Of these nuchal cords, 75.81% were loose and 24.18% were tight. Cesarean delivery rate was lower in the loose and tight nuchal cord groups when compared with control group (P <.001;P < .05). Low Apgar scores < 7 at the 1st and 5th minutes were less in the loose nuchal cord group when compared with control group (P = .06, P = .7). In tight nuchal cord group, low Apgar score < 7 at the 1st minute was significantly higher, when low Apgar score < 7 at the 5th minute was non significantly higher when compared with control group (P < .001, P = .14). Transfer rate to neonatology unit was lower in the loose and tight nuchal cord than in the control group. Loose nuchal cord may not be associated with adverse perinatal outcome. However, tight nuchal cord may be associated with increased risk of low Apgar score < 7 at the 1st minute. Consequently, the ultrasound diagnosis of a nuchal cord at the end of pregnancy should not be the indication of elective cesarean delivery.

Bone morphogenetic protein signaling: a promising target for white matter protection in perinatal brain injury.

Bone morphogenetic protein signaling: a promising target for white matter protection in perinatal brain injury.

Prenatal, perinatal and neonatal risk factors for perinatal arterial ischaemic stroke: a systematic review and meta-analysis.

The aim of the present study was to perform a meta-analysis of published data to determine the significance of clinical factors and exposures to the risk of perinatal arterial ischaemic stroke (PAIS) and provide guidance for clinical diagnosis and treatment. A comprehensive literature search of the PubMed, Embase, MEDLINE and Cochrane Library databases for relevant observational studies (cohort/case-control) from March 1984 to March 2016 was undertaken. Two review authors independently examined the full text records to determine which studies met the inclusion criteria and evaluated risk factors for PAIS. Risk ratios, odds ratios and 95% confidence intervals were estimated. A total of 11 studies were included in the analyses. Intrapartum fever >38°C, pre-eclampsia, oligohydramnios, primiparity, forceps delivery, vacuum delivery, fetal heart rate abnormalities, abnormal cardiotocography tracing, cord abnormalities, birth asphyxia, emergency caesarean section, tight nuchal cord, meconium-stained amniotic fluid, umbilical arterial pH <7.10, Apgar score at 5 min <7, resuscitation at birth, hypoglycaemia, male gender and small for gestational age were identified as risk factors for PAIS. This systemic review and meta-analysis provides a preliminary evidence-based assessment of the risk factors for PAIS. Patients with any of the risk factors identified in this analysis should be given careful consideration to ensure the prevention of PAIS. Future studies focusing on the combined effects of multiple prenatal, perinatal and neonatal risk factors for PAIS are warranted.

Incidence of cord around the neck and its effects on labour and neonatal outcome

Background: The umbilical cord is a narrow tube-like structure that connects the developing baby to the placenta. Most of the nuchal cords diagnosed in early pregnancy get spontaneously uncoiled. This study was carried out to show that such natural occurrence does not have significant effect on pregnancy, labour and neonates if proper intra-partum foetal heart rate (FHR) monitoring could be provided by a caregiver. Materials and Methods: This study was conducted in the Department of Obstetrics and Gynaecology at Sardar Patel Medical College, Bikaner (Rajasthan). For completing 100 cases with nuchal cord, we had to observe 506 cases and by which we took out the incidence of nuchal cord and which was separately categorised into single, double, triple and four and more than four groups. Results: The present study showed mean cord length also increases with number of loops (50.93 cm in single loop as compared to 72.33 cm) in cases with four loops and showed that patients having tight nuchal cord have higher incidence of caesarean as well as forceps delivery, but these were not statistically significant (P = 0.56 and P= 0.57) and Apgar score <7 at 1 min, FHR deceleration and meconium staining of liquor were statistically higher significant (P = 0.001,P= 0.0001 and P= 0.001, respectively). Conclusion: At present, expertise to diagnose multiple and tight loops on ultrasound are limited, which should be the aim for future. Multicentric and large studies are further required in association with more specific and sensitive diagnostic aid for tight and multiple loops so as to provide the best perinatal management with good foetal outcome.

A Model Practice Template for Hydrotherapy in Labor and Birth.

A Model Practice Template for Hydrotherapy in Labor and Birth.

Risk Factors for Neonatal Arterial Ischemic Stroke: The Importance of the Intrapartum Period

To investigate risk factors for neonatal arterial ischemic stroke (NAIS), and compare them with those present in term controls and infants with hypoxic-ischemic encephalopathy (HIE). Antepartum and intrapartum data were collected at presentation from 79 infants with NAIS and compared with 239 controls and 405 infants with HIE. The relationships between risk factors and NAIS were explored using univariable and multivariable regression. Compared with controls, infants with NAIS more frequently had a family history of seizures/neurologic diseases, primiparous mothers, and male sex. Mothers of infants with NAIS experienced more intrapartum complications: prolonged rupture of membranes (21% vs 2%), fever (14% vs 3%), thick meconium (25% vs 7%), prolonged second stage (31% vs 13%), tight nuchal cord (15% vs 6%), and abnorm8al cardiotocography (67% vs 21%). Male sex (OR 2.8), family history of seizures (OR 6.5) or neurologic diseases (OR 4.9), and ≥1 (OR 5.8) and ≥2 (OR 21.8) intrapartum complications were independently associated with NAIS. Infants with NAIS and HIE experienced similar rates though different patterns of intrapartum complications. Maternal fever, prolonged rupture of membranes, prolonged second stage, tight nuchal cord, and failed ventouse delivery were more common in NAIS; thick meconium, sentinel events, and shoulder dystocia were more frequent in HIE. Abnormal cardiotocography occurred in 67% of NAIS and 77.5% of infants with HIE. One infant with NAIS and no infant with HIE was delivered by elective cesarean (10% of controls). NAIS is multifactorial in origin and shares risk factors in common with HIE. Intrapartum eventsmay play a more significant role in the pathogenesis of NAIS than previously recognized.

Severe antenatal strangulation and sudden fetal death occurs in term: case report

The authors report a case of a sudden antenatal death, by severe strangulation, unlikely related in a term pregnancy; multiple loops of nuchal umbilical cord (UC) (ten), rarely describe in literature, were observed around the fetal neck. The in utero fetal death (IFD) was suspected by the non-attendance of fetal movements and confirmed by US scan. The tight nuchal cord around the neck (tCAN) diagnostic was made during caesarean delivery, as it was not discovered in pregnancy US scan monitoring nor in the US scan made in emergency. The newborn examination shows severe fetal strangulation by the presence of many spires of a too long UC (1.50 m). Autopsy was not been accepted by the family. Through this reported case the authors wanted to show the difficulties of its diagnosis in less developed Sub-Saharan country were US scan practice is not usual.

Перинатальні фактори ризику гіпоксично-ішемічної енцефалопатії у доношених новонароджених із нормальною та низькою до терміну гестації масою тіла

На базі відділення патології новонароджених обласної дитячої клінічної лікарні м. Чернівців обстежено 41 доношену дитину, хвору на гіпоксично-ішемічну енцефалопатію, з метою вивчення перинатальних факторів ризику захворювання залежно від маси тіла при народженні. Встановлено, що основними предикторами розвитку гіпоксично-ішемічної енцефалопатії у маловагових до терміну гестації новонароджених є: проживання матерів у міських поселеннях (46,2 %); наявність хронічної патології (анемії, захворювань щитоподібної залози) у матерів під час вагітності (46,6 %); супутні вроджені аномалії розвитку у третини (30,8 %) новонароджених; розвиток респіраторних порушень при народженні, що потребували проведення штучної вентиляції легень (61,5 %); проблеми вигодовування новонароджених (61,5 %). Гіпоксично-ішемічному ураженню центральної нервової системи у доношених новонароджених із нормальною відносно терміну гестації масою тіла передували: патологічний перебіг інтранатального періоду (розвиток дистресу плода в пологах унаслідок обвиття пуповиною у чверті випадків і патологічний перебіг пологів у третині (32,1 %) спостережень), що асоціював із народженням третини малюків в асфіксії (констеляція Апгар-тесту на 1-й хвилині ≤ 4 бали), яка часто призводила до розвитку кардіогенних ускладнень (28,6 %), поліорганної недостатності (14,3 %) і судомного синдрому (17,9 %).

Severe Pancreatitis Exacerbation in a Perinatal Patient with Severe Preeclampsia

<h2>Poster Presentation</h2><h3>Background</h3> Pancreatitis in pregnancy is rare, and when complicated, mortality may exceed 10%. The subject of this case report also had severe preeclampsia, which stimulated discussion of the new guidelines from the Task Force on Hypertension in Pregnancy. This poster presentation will provide education about a rare condition and also review important points in the hypertension guidelines. <h3>Case</h3> The woman presented at 39 weeks gestation with abdominal pain, nausea, and vomiting but no scotoma or headache. Her blood pressure was 180–190/110–120. Labs were unremarkable, except for lipase, which was >4000 (normal 20–300). Prior to pregnancy her lipase was 9500, and pancreatectomy and islet cell transplantation were recommended, but she did not follow up. Instead, the woman had been using narcotics daily at home via a peripherally inserted central catheter (PICC). She was treated for preeclampsia with antihypertensives and magnesium sulfate. Consults were ordered with pain management, surgery, gastroenterology, maternal‐fetal medicine (MFM), and neonatology. The attending physician on call wanted to perform an emergency cesarean, but MFM recommended stabilization, and the surgery consult concurred. A male was born with a tight nuchal cord, was intubated, and was transported to the neonatal intensive care unit (NICU). The woman's postpartum course consisted primarily of nutrition support and pain management, but on postpartum Day 3 she needed a transfusion due to hemoglobin of 6.1. On Day 6, creatinine levels rose to 1.7 and her blood pressure became elevated again, so a nephrology consult was added. On Day 7, she developed a headache and 3+ pretibial edema, so magnesium sulfate was restarted. The newborn underwent body cooling due to hypoxic ischemic encephalopathy but was discharged at 12 days of life in stable condition. The woman was finally discharged on postpartum Day 15, with oral analgesics and on total parenteral nutrition. She was to follow up with the same specialists who recommended the pancreatectomy. <h3>Conclusion</h3> Pancreatitis is an inflammatory state that can cause respiratory failure, renal failure, and cardiac complications due to the pancreatic enzymes being released into the circulation. Treatment is to alleviate the inflammation and symptoms. Perinatal nurses need to know that a more typically seen condition in pregnancy‐gallbladder disease can precipitate pancreatitis. Two points that stood out in this scenario were the insistence on stabilization of the woman prior to cesarean, which is always recommended in the literature but not always practiced. Second, magnesium sulfate was restarted because of an earnest attempt at our institution to follow the taskforce guidelines.

PO-0662 Umbilical Cord Blood Gases Analysis In Pregnancies Complicated By Nuchal Cord

Introduction Cardio-pulmonary compromise in fetus and newborn secondary to loose or tight nuchal cord at or prior to delivery is an important area for research. Our aim in this study is to evaluate umbilical arterial (UA) and venous (UV) pH, pO 2 , pCO 2 , base deficit and the umbilical veno-arterial difference (Uv-a) in these parameters in newborns born following nuchal cord. Methodology UA and UV pH, pO 2 , pCO 2 , and base deficit of 47 newborns born following tight nuchal cord, 44 newborns born following single loose nuchal cord and 44 newborns born without nuchal cord were compared across. Results Mean UA pH (7.25 vs. 7.28) was lower in the nuchal cord group and mean UA pCO 2 (58.11 vs. 54.38) was higher in the nuchal cord group; however the difference was not statistically significant. No difference was found in pO 2 or base deficit across groups. However, nuchal cord to control group comparisons of U v-a pH and U v-a pCO 2 change were both significant (p 2 differences between control and tight nuchal cord were observed. U v-a pO 2 difference and U v-a base deficit difference was also non-significant across groups. Discussion UA acidosis was observed in group with nuchal cord, as seen by lower mean UA pH and elevated UA pCO 2 (statistical non-significance could be due to low power) and U v-a difference in pH and pCO 2 (statistically significant). Large prospective studies would be needed to clearly understand the patho-physiology of acidosis in newborns born following nuchal cord.

PO-0720 Perinatal Characteristics Of Pregnancies Complicated By Nuchal Cord At Delivery

<h3>Introduction</h3> Earlier studies (small numbers and/or anecdotal case reports) have reported adverse neonatal outcomes following nuchal cord at delivery. More recent studies (larger numbers and/or with control group) have reported opposite results. <h3>Methodology</h3> We conducted a retrospective review of deliveries from 2012, particularly presence of nuchal cord at delivery. We reviewed these records in reference to maternal characteristics (gestation, race, gravida, gestational age), antenatal complications (mode of delivery, amniotic fluid, fetal growth restriction, hypertension), intrapartum non reassuring fetal heart tones, low apgar scores, respiratory morbidity, and intensive care unit admission. <h3>Results</h3> 2530 deliveries occurred in 2012. Incidence of nuchal cord at delivery was 23.5% (single loop 18.8%, multiple loops 2.8% and tight nuchal cord 1.9%). Nuchal cord occurred more frequently in singleton pregnancies compared to multiple pregnancies (p value = 0.001). We did not observe any significant difference between nuchal cord and non-nuchal cord group as far as variables such as race, gravida, gestational age, mode of delivery, oligo or polyhydramnios, fetal growth restriction, and maternal hypertension was concerned. Incidence of non-reassuring fetal heart tones was more frequent in nuchal cord group compared to non-nuchal cord (p = 0.000). Apgar scores, need for resuscitation, respiratory morbidities, and admission to intensive care unit between the two groups were similar (non-significant). <h3>Conclusion</h3> Incidence of nuchal cord in our study is similar to that reported in other studies. Nuchal cord was more frequent in singleton pregnancies, and was accompanied by non-reassuring fetal heart tone pattern. Obstetric and neonatal morbidities were similar across two groups.

Antepartum and Intrapartum Factors Preceding Neonatal Hypoxic-Ischemic Encephalopathy

To determine whether antepartum factors alone, intrapartum factors alone, or both in combination, are associated with term neonatal hypoxic-ischemic encephalopathy (HIE). A total of 405 infants ≥ 35 weeks' gestation with early encephalopathy, born between 1992 and 2007, were compared with 239 neurologically normal infants born between 1996 and 1997. All cases met criteria for perinatal asphyxia, had neuroimaging findings consistent with acute hypoxia-ischemia, and had no evidence for a non-hypoxic-ischemic cause of their encephalopathy. Both antepartum and intrapartum factors were associated with the development of HIE on univariate analysis. Case infants were more often delivered by emergency cesarean delivery (CD; 50% vs 11%, P < .001) and none was delivered by elective CD (vs 10% of controls). On logistic regression analysis only 1 antepartum factor (gestation ≥ 41 weeks) and 7 intrapartum factors (prolonged membrane rupture, abnormal cardiotocography, thick meconium, sentinel event, shoulder dystocia, tight nuchal cord, failed vacuum) remained independently associated with HIE (area under the curve 0.88; confidence interval 0.85-0.91; P < .001). Overall, 6.7% of cases and 43.5% of controls had only antepartum factors; 20% of cases and 5.8% of controls had only intrapartum factors; 69.5% of cases and 31% of controls had antepartum and intrapartum factors; and 3.7% of cases and 19.7% of controls had no identifiable risk factors (P < .001). Our results do not support the hypothesis that HIE is attributable to antepartum factors alone, but they strongly point to the intrapartum period as the necessary factor in the development of this condition.

Is nuchal cord a perfect scapegoat: A retrospective analysis from Northwest India?

Background: Entanglement of the umbilical cord around the fetal neck (nuchal cord) is quite a common fi nding at delivery. It is often assumed that nuchal cord causes cord compression and thus low birth weight and intrapartum complications. Aim: The aim of this article is to study the eff ect of nuchal cord on the mode of delivery, complications and fetal outcome. Materials and Methods: A retrospective study was carried out on 386 deliveries, 60 of them with nuchal cord, during 1 year from November 2009 through October 2010. Their mode of delivery, complications and fetal outcome were studied and a comparison was established between nuchal cord group and the rest of the deliveries. Nuchal cord group was subdivided into loose nuchal cord (cord could easily be uncoiled before complete delivery of the baby) group and tight nuchal cord (cord was needed to be clamped and cut before delivery of the baby) group. Furthermore, the mode of delivery and fetal outcome were compared between these subgroups. Statistical analyses were performed using SPSS statistical soft ware version 12.0 (Chicago Illinios, USA). The results were expressed as percentages. Test for significance was done using Chi-square, and a P<0.05 was considered as significant. Results: The nuchal cord group did not have any signifi cant diff erence in the mode of delivery or fetal outcome compared with the control group. However, the subgroup having tight cord around the neck had significantly higher proportion of low Apgar scores and meconium staining at birth. Conclusions: Nuchal cord does not increase the chances of cesarean delivery. However, tight cord around the neck may result in low Apgar scores and increased incidence of fetal distress leading to cesarean section. Keywords: Apgar score, cesarean delivery, meconium staining, north west India, nuchal cord, perinatal outcome

Neonatal outcomes following a tight nuchal cord

The best practices for the care of a neonate born after a tight nuchal cord have not been defined. As a step toward this, we compared the outcomes of neonates born after a tight nuchal cord vs those born after a loose nuchal cord vs those born after no nuchal cord. This was a retrospective comparison using electronic data of all deliveries during a 6-year period (2005 to 2010) in a multihospital healthcare system in the western United States. At the time of delivery, each birth was recorded as having a tight nuchal cord, a loose nuchal cord or no nuchal cord. Nuchal cord was defined as a loop of umbilical cord ≥360° around the fetal neck. 'Tight' was defined as the inability to manually reduce the loop over the fetal head, and 'loose' as the ability to manually reduce the loop over the head. Of 219,337 live births in this period, 6.6% had a tight nuchal cord and 21.6% had a loose nuchal cord. Owing to the very large number of subjects, several intergroup differences were statistically significant but all were judged as too small for clinical significance. For instance, those with a tight nuchal cord had a very slightly older gestational age, a very slightly lower birth weight, a preponderance of male fetuses, primagravid women, singleton pregnancies and shoulder dystocia (all P<0.001). Term neonates with a tight nuchal cord were slightly more likely to be admitted to a Neonatal Intensive Care Unit (6.6% vs 5.9% admission rate, P=0.000). Those with a tight nuchal cord were not more likely to have dopamine administered or blood hemoglobin measured on the first day, nor were they more likely to receive a transfusion or to die. The subset of very low birth weight neonates with a tight nuchal cord, compared with those with no nuchal cord, were of the same gestational age and birth weight, with the same Apgar scores, and were not more likely to have severe intraventrucular hemorrhage, retinopathy of prematurity or periventricular leukomalacia, or to die. The presence of a tight nuchal cord is not uncommon, occurring in 6.6% of over 200,000 consecutive live births in a multihospital health system. No differences in demographics or outcomes, judged as clinically significant, were associated with a tight nuchal cord. Thus, we speculate that the best practices for neonatal care after a tight nuchal cord do not involve an obligation to conduct extra laboratory studies or extra monitoring solely on the basis of the report of a tight nuchal cord.

P.7.005 BDNF gene polymorphism and Wisconsin Card Sorting Test in children with ADHD and healthy controls

OBJECTIVE: Our purpose was to examine the association of cerebral palsy with conditions that can interrupt oxygen supply to the fetus as a primary pathogenetic event.STUDY DESIGN: A population-based case-control study was performed in four California counties, 1983 through 1985, comparing birth records of 46 children with disabling spastic cerebral palsy without recognized prenatal brain lesions and 378 randomly selected control children weighing ≥2500 g at birth and surviving to age 3 years.RESULTS: Eight of 46 children with otherwise unexplained spastic cerebral palsy, all eight with quadriplegic cerebral palsy, and 15 of 378 controls had births complicated by tight nuchal cord (odds ratio for quadriplegia 18, 95% confidence interval 6.2 to 48). Other potentially asphyxiating conditions were uncommon and none was associated with spastic diplegia or hemiplegia. Level of care, oxytocin for augmentation of labor, and surgical delivery did not alter the association of potentially asphyxiating conditions with spastic quadriplegia. Intrapartum indicators of fetal stress, including meconium in amniotic fluid and fetal monitoring abnormalities, were common and did not distinguish children with quadriplegia who had potentially asphyxiating conditions from controls with such conditions.CONCLUSION: Potentially asphyxiating conditions, chiefly tight nuchal cord, were associated with an appreciable proportion of unexplained spastic quadriplegia but not with diplegia or hemiplegia. Intrapartum abnormalities were common both in children with cerebral palsy and controls and did not distinguish between them. (Am J Obstet Gynecol 1998;179:507-13.)