Fetal Demise Due to Cord Entanglement in the Early Second Trimester

Ergin, Rahime Nida; Yayla, Murat; Ergin, Ayse Seda

doi:10.1080/08998280.2014.11929092

Cited by 1 publication

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“…Mid-trimester stillbirth attributed to nuchal cord entanglement has been reported rarely (in association with “multiple tight loops of nuchal cord and a markedly thinned and elongated fetal neck”). 31 , 53 , 54 Other than attention to the above-mentioned potential indirect sonographic effects of nuchal cords during the mid-trimester, no benefit in clinical outcome has been reported with such early diagnosis of this condition, which commonly reduces spontaneously with advancing gestational age, as described by Tepper et al 50 Any potential impact upon perinatal outcome therefore remains limited to the third trimester, which will be detailed in the following section.…”

Section: Nuchal Cord(s) In the Mid-trimestermentioning

confidence: 99%

<p>Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of Nuchal Cord(s)</p>

Sherer¹,

Ward²,

Bennett³

et al. 2020

IJWH

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Umbilical cord accidents preceding labor are uncommon. In contrast, nuchal cords are a very common finding at delivery, with reported incidences of a single nuchal cord of approximately between 20% and 35% of all singleton deliveries at term. Multiple loops occur less frequently, with reported incidence rates inverse to the number of nuchal cords involved. Rare cases of up to 10 loops of nuchal cord have been reported. While true knots of the umbilical cord have been associated with a 4-10-fold increased risk of stillbirth, nuchal cord(s) are most often noted at delivery of non-hypoxic non-acidotic newborns, without any evidence of subsequent adverse neonatal outcome. Prior to ultrasound, nuchal cords were suspected clinically following subtle (spontaneous or evoked) electronic fetal heart rate changes. Prenatal sonographic diagnosis, initially limited to real-time gray-scale ultrasound, currently entails additional sonographic modalities, including color Doppler, power Doppler, and three-dimensional sonography, which have enabled increasingly more accurate prenatal sonographic diagnoses of nuchal cord(s). In contrast to true knots of the umbilical cord (which are often missed at sonography, reflecting the inability to visualize the entire umbilical cord, and hence are often incidental findings at delivery), nuchal cord(s), reflecting their well-defined and sonographically accessible anatomical location (the fetal neck), lend themselves with relative ease to prenatal sonographic diagnosis, with increasingly high sensitivity and specificity rates. While current literature supports that single (and possibly double) nuchal cords are not associated with increased adverse perinatal outcome, emerging literature suggests that cases of ≥3 loops of nuchal cords or in the presence of a coexisting true knot of the umbilicus may be associated with an increased risk of stillbirth or compromised neonatal status at delivery. This commentary will address current perspectives of prenatal sonographic diagnosis and clinical management challenges associated with nuchal cord(s) in singleton pregnancies.

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