Overburdened and undernourished

Bord, A.; Valsky, D. V.

doi:10.1016/j.ajog.2007.07.011

Cited by 5 publications

(7 citation statements)

References 5 publications

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“…A systematic English literature search (PubMed, MEDLINE) for articles between 1966 and 2017 utilizing the search terms 'pregnancy', 'fetal growth restriction', 'nuchal cord', 'ultrasound' and 'Doppler velocimetry' revealed this to be the first case of fetal growth restriction at term associated with persistent multiple nuchal cords, despite normal umbilical artery systolic-to-diastolic ratio. Our case supports the association between early fetal growth restriction and quadruple nuchal cord, as reported by Bord et al 5 , and suggests that impaired fetal growth associated with multiple nuchal cords may be independent of increased placental blood flow resistance.…”

Section: Letters To the Editorsupporting

confidence: 92%

Persistent quadruple nuchal cord throughout the third trimester associated with decelerating fetal growth

Sherer

Dalloul

Sabir

et al. 2017

Ultrasound in Obstet & Gyne

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Section: Letters To the Editorsupporting

confidence: 92%

Persistent quadruple nuchal cord throughout the third trimester associated with decelerating fetal growth

Sherer

Dalloul

Sabir

et al. 2017

Ultrasound in Obstet & Gyne

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“…85 Following depiction of severe early symmetrical fetal growth restriction with a quadruple nuchal cord at 30 weeks' gestation, electronic fetal heart rate monitoring revealed repeated severe variable decelerations necessitating Cesarean delivery of a non-asphyxiated, markedly growth-restricted neonate weighing 840 grams with a tight quadruple nuchal cord. 85 Hoh et al in 2012, in data regarding 150 cases with nuchal cords (300 cases without nuchal cords, 124 cases of single nuchal cord, and 26 with multiple nuchal cords), noted that the birth weight of infants with multiple nuchal cords was significantly lower than that of infants without nuchal cords (3317±24 grams versus 3054±55 grams, P=0.0008). 86 Similarly, we followed a patient with a persistent quadruple nuchal cord throughout the third trimester (Figure 4).…”

Section: Fetal Growthmentioning

confidence: 99%

“…Bord et al in 2007 reported a case of marked fetal growth restriction and multiple nuchal cords. 85 Following depiction of severe early symmetrical fetal growth restriction with a quadruple nuchal cord at 30 weeks’ gestation, electronic fetal heart rate monitoring revealed repeated severe variable decelerations necessitating Cesarean delivery of a non-asphyxiated, markedly growth-restricted neonate weighing 840 grams with a tight quadruple nuchal cord. 85 …”

Section: Possible Confounding Factorsmentioning

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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“…It is important to consider the (rarely) reported possible association between complex umbilical cord entanglement and fetal growth restriction. 45–47 This is of special importance when the diagnosis of complex umbilical cord entanglement occurs in prematurity (or extreme prematurity) in that diagnosis of the latter may precede the fetal growth restriction, which may only become established/recognized considerably later in gestation. Delivery in prematurity may in these rare occurrences, become indicated due to matters relating to fetal growth restriction rather than the associated complex umbilical cord entanglement (or a combination of both of these conditions).…”

Section: Complex Umbilical Cord Entanglementmentioning

confidence: 99%

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

Sherer¹,

Roach²,

Soyemi³

et al. 2021

IJWH

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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.

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Overburdened and undernourished

Cited by 5 publications

References 5 publications

Persistent quadruple nuchal cord throughout the third trimester associated with decelerating fetal growth

Persistent quadruple nuchal cord throughout the third trimester associated with decelerating fetal growth

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

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

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