Nuchal cords: Timing of prenatal diagnosis and duration

Collins, Jason H.; Collins, Charles L.; Weckwerth, Stacey R.; Angelis, Lorraine De

doi:10.1016/0002-9378(95)90337-2

Cited by 44 publications

(32 citation statements)

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“…There are many umbilical cord masses, such as teratoma, hemangioma, hematoma, allantoic cyst, omphalomesenteric duct cyst, and metastatic neuroblastoma [2,3]. Nuchal cords can form before delivery and present a sudden risk to an otherwise uneventful pregnancy [6]. Fetal bleeding from ruptured vasa praevia due to velamentous umbilical cord insertion is an unexpected and fatal complication of pregnancy which can only be avoided with proper antenatal diagnosis and elective delivery by cesarean section [8].…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Ultrasonographic Assessment of the Umbilical Cordduring the 2nd and 3rd Tri mesters of Pregnancy

Hata

Aoki²,

Hata³

et al. 1998

Gynecol Obstet Invest

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Objective: To evaluate the umbilical cord and its abnormalities by use of three-dimensional ultrasonography with a specially developed abdominal three-dimensional transducer. Patients and Methods: Ninety-five pregnancies (92 normal, 2 with hydrops fetalis, and 1 with omphalocele) from 14 to 40 weeks of gestation were studied with a specially developed abdominal three-dimensional transducer (3.5 MHz). This system can provide conventional two-dimensional ultrasonography images and can also generate within seconds high-quality three-dimensional images in the surface and transparent mode with no need for an external workstation. A proportion of the umbilical cords (coiled or noncoiled free loop, abdominal insertion, and placental insertion) visualized at each gestational age interval is presented. Results: The proportion of the umbilical cords visualized during pregnancy except for between 24 and 27 weeks of gestation was about 70% (range 64–83%). Optimal visualization of the umbilical cord was achieved between 24 and 27 weeks of gestation. During this period it was possible to adequately depict the umbilical cord in 93% of the cases. The proportions of the noncoiled umbilical cord depicted during pregnancy ranged from 8 to 45%. The detection rate of abdominal insertion of the umbilical cord visualized at 14–19 weeks was 44%; the detection rate decreased thereafter. Placental insertion of the umbilical cord could not be identified after 28 weeks of gestation. In 2 cases with hydrops fetalis, edematous umbilical cord was evident. In 1 fetus, omphalocele was clearly depicted. Conclusions: The new three-dimensional ultrasound technology generates within seconds high-quality three-dimensional images of the umbilical cord, although limitation of viewing direction exists. These results suggest that the new three-dimensional ultrasonography has the potential to be a supplement to two-dimensional ultrasonography and might be useful in identifying abnormal umbilical cords in utero.

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Section: Discussionmentioning

confidence: 99%

Three-Dimensional Ultrasonographic Assessment of the Umbilical Cordduring the 2nd and 3rd Tri mesters of Pregnancy

Hata

Aoki²,

Hata³

et al. 1998

Gynecol Obstet Invest

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“…We have recently reported that infants with the umbilical cord around the neck at birth are smaller than those without cord complications, and also that their placentas are larger (Osak et al 1997). Nuchal cord encirclements are detected several weeks prior to labour and delivery (Collins et al 1995) and therefore the mechanisms underlying the decreased birth weight are likely to involve a reduction in umbilical blood flow and thus altered nutrient and/or oxygen delivery. The increased placental weight may represent an adaptive overgrowth to sustain nutrient supply, as seen in humans with mild hypoxaemia at high altitude (see Barker 1994) and in some instances of maternal undernutrition in sheep (McCrabb et al 1991).…”

Section: Introductionmentioning

confidence: 99%

The effect of intermittent umbilical cord occlusion on insulin-like growth factors and their binding proteins in preterm and near-term ovine fetuses

Green

Kawagoe²,

Hill³

et al. 2000

Journal of Endocrinology

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Intermittent umbilical cord compression with resultant fetal hypoxia can have a negative impact on fetal growth and development. Insulin-like growth factors (IGFs) and their binding proteins (IGFBPs) are the most important regulators of fetal growth. In preterm (107-108 days of gestation) and near-term (128-131 days of gestation) ovine fetuses, we have determined the effect of intermittent umbilical cord occlusion (UCO) over a period of 4 days on the profile and expression of IGFs and IGFBPs. In experimental group animals (preterm n=7; near term n=7) UCOs were carried out by complete inflation of an occluder cuff (duration 90 s) every 30 min for 3-5 h each day, while control fetuses (preterm n=7; near term n=7) received no UCOs. Ewes were euthanized at the end of day 4, and fetal heart, lung, kidney, liver, skeletal muscle and placenta were collected. During UCOs, PO 2 fell (by 13 mmHg), pH fell (by 0·05) and PCO 2 increased (by 7 mmHg), and changed to a similar extent in both preterm and near-term groups. In both preterm and near-term groups, there was no difference in fetal body or organ weight between UCO and control fetuses. No significant changes were observed in plasma IGF-I and -II concentrations or IGFBP-1, -2, -3 or -4 levels throughout the 4-day study at either gestational age. In the preterm group UCO fetuses, IGF-II mRNA (1·2-6·0 kb) levels were lower in fetal lung (33%, P<0·05), heart (54%, P<0·01) and skeletal muscle (29%, P<0·05), but there were no differences in IGF-I mRNA levels (7·3 kb); IGFBP-2 mRNA (1·5 kb) levels were lower in the right lobe of the liver (42%, P<0·05) and kidney (22%, P<0·01), but higher in the heart (72%, P<0·01), while IGFBP-4 (2·4 kb) levels were lower in skeletal muscle (21%, P<0·01). In the near-term group UCO fetuses, IGFBP-2 mRNA levels were greater in the placenta (39%, P<0·05). Thus, intermittent UCO as studied has a greater effect on the expression of genes encoding certain peptides of the fetal IGF system in selected tissues in preterm fetuses than that in near-term fetuses. Altered IGFBP-2 mRNA levels with reduced IGF-II mRNA levels in selected tissues may mediate changes in growth and/or differentiation that might become apparent if the length of the UCO study were extended.

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“…Limited information is available about the likelihood of a nuchal cord resolving after 36 weeks of gestation. Nuchal cord resolution can occur, as described by Collins et al [15]. In a prospective ultrasound evaluation of 231 patients at 20, 28 and 35 weeks of gestation, 30 patients were diagnosed prenatally with a nuchal cord.…”

Section: Resultsmentioning

confidence: 99%

Double Nuchal Umbilical Cord and Breech Presentation

Al‐Kouatly

Schuster

Skupski

2003

Gynecol Obstet Invest

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We report the management of a fetus with breech presentation and double nuchal cord in a mother desiring external cephalic version (ECV). The patient was a 26-year-old woman, gravida 1, para 0, with an unremarkable prenatal course, who was found to have a breech presentation at 34 weeks 1 day. She consented for external cephalic version (ECV) and upon evaluation at 36 weeks 2 days, the fetus was found to have double nuchal coils of the umbilical cord. ECV was not attempted. Subsequent fetal surveillance consisted of fetal movement counts, non-stress tests and Doppler ultrasound of the umbilical artery. At 38 weeks 1 day, ultrasound revealed absence of the nuchal coils. ECV was attempted and was successful. The fetus maintained the cephalic presentation and the patient delivered uneventfully. This case report illustrates the value of follow-up ultrasound in a patient who desires an ECV and for whom such a procedure was declined due to the presence of double nuchal coils. Cesarean delivery was successfully avoided.

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Nuchal cords: Timing of prenatal diagnosis and duration

Cited by 44 publications

References 1 publication

Three-Dimensional Ultrasonographic Assessment of the Umbilical Cordduring the 2nd and 3rd Tri mesters of Pregnancy

Three-Dimensional Ultrasonographic Assessment of the Umbilical Cordduring the 2nd and 3rd Tri mesters of Pregnancy

The effect of intermittent umbilical cord occlusion on insulin-like growth factors and their binding proteins in preterm and near-term ovine fetuses

Double Nuchal Umbilical Cord and Breech Presentation

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