Prenatal color Doppler sonographic evaluation of nuchal encirclement by the umbilical cord

Abstract

Color Doppler sonography is a sensitive and specific method of diagnosing nuchal cord, but fetal middle cerebral artery and umbilical artery Doppler flow velocimetry values are not affected by the presence of nuchal cord in the prenatal period.

Umbilical Cord Entanglement: Diagnostic and Clinical Repercussions

“…11 A greater incidence of nuchal cord has been reported in white women and in male fetuses. 11,32,40 There are multiple reports in the world literature that address the implications of cord entanglement during labor, delivery, and in newborn babies, but only a few, like this one, follow this event throughout the entire gestation. We have used for this study 3D/4D ultrasound assisted with Doppler and 3D angiography, which are aids that afford great diagnostic precision.…”

“…If cord compression is not prolonged, flow does not cease in any significant way and fetal reserve can maintain adequate oxygenation. 32 Nevertheless, the numer of coils was reduced in nuchal cords and there was an inverse relationship between the number of coils and susceptibility to cord occlusion. 2 Maybe nuchal cords predispose to cord compression that can be associated with a higher rate of bradycardias, variable decelerations, umbilical cord acidemia, an increase in free oxygen radicals, and although rare, fetal demise.…”

“…2 Maybe nuchal cords predispose to cord compression that can be associated with a higher rate of bradycardias, variable decelerations, umbilical cord acidemia, an increase in free oxygen radicals, and although rare, fetal demise. 12,32 When there is cord occlusion, the most frequent change in fetal heart rate observed is variable deceleration. 11 For this reason a significant increase in alterations of intrapartum fetal heart rate patterns has been described.…”

Asphyxie périnatale et infirmité motrice d’origine cérébrale (II – Implications médico-légales et prévention)

“…À cet égard, plusieurs recommandations peuvent être faites : utiliser la manoeuvre de Hon avant toute rupture artificielle des membranes alors que la tête foetale n'est pas encore engagée : la pression fundique ou sus-pubienne appliquée à la tête foetale vers le bassin osseux maternel provoquant une bradycardie doit faire craindre un procubitus du cordon ou des vasa praevia, voire un circulaire serré [131]. Dans le contexte d'un ralentissement prolongé déclenché par cette manoeuvre, avec la levée rapide de la décélération à l'arrêt de la pression, la pratique d'une échographie Doppler couleur en urgence peut s'avérer utile pour visualiser la position anormale des vaisseaux funiculaires ou l'enroulement des circulaires du cordon [132,133] ; renforcer la surveillance des utérus cicatriciels et exiger la présence de l'accoucheur dans les murs de la maternité jusqu'à la naissance de l'enfant ; obtenir un enregistrement correct des contractions utérines pendant tout l'accouchement afin d'interpréter avec pertinence les ralentissements du RCF et d'empêcher les hyperstimulations utérines induites par l'ocytocine ( Fig. 1).…”

The specificity of color Doppler ultrasound to detect fetal hypoxia in pregnancy-induced-hypertension with thyroid dysfunction

“…Fetal hypoxia can cause brain sparing effect that is characterized by the decreasing of hemodynamic index of MCA and increasing of cerebral blood flow in different extent [3][4][5][6]. Umbilical vessels are the only passageways linking fetus and placenta, the blood flow variation of which can reflect changes of placenta function [7]. The intrahepatic resistance in placenta increases when fetal hypoxia occurs.…”