SUMMARY Two neonates who went. into acute hypovolaemic shock due to a tight nuchal cord were successfully resuscitated. The occurrence of this life threatening complication in two low risk pregnancies emphasises the importance of having staff trained in resuscitation immediately available in the delivery unit. The infant was extremely hypotonic and pale, with a tachycardia. The peripheral pulses were weak, and there were signs of poor capillary perfusion. There was no oedema or splenohepatomegaly. Five minutes after birth the pH of the infant's blood was 7 05. He was immediately intubated and 50 ml of plasma given through a venous umbilical catheter in the delivery room. Shortly afterwards 75 ml of whole blood was transfused because of the suspicion of acute fetal blood loss. Venous haematocrit before the blood transfusion was 33%. Examination of a peripheral blood smear showed a normochromic normocytic anaemia (haemoglobin concentration 90 g/l) without normoblastosis. A few hours after the blood transfusion the child was extubated and 48 hours later he was transferred to the postnatal ward, from which he was discharged in good health when 6 days old.In this case there was no fetomaternal blood group incompatibility and the direct Coombs' test was negative. The placenta (700 g) and the umbilical cord (length 42 cm) were normaL Cord insertion was paramarginal without aberrant vessels. Fetal membranes were complete and there were no blood. clots on the maternal surface of the placenta. Fetomaternal transfusion was excluded because the Kleihauer test performed six hours after delivery was negative. The infant had no signs of external or internal haemorrhage. Ultrasound and computed tomography scans of the brain and abdominal ultrasound examination yielded normal results. CASE 2 A baby boy weighing 3010 g was born at a gestational age of 38 weeks. The mother was 29 years old, healthy, normotensive and multiparous. The cervix was softened by extra-amniotic instillation of prostaglandin E2 gel, and low amniotomy was performed two hours before delivery. The liquor was clear. Epidural anaesthesia (12 ml 0-25% bupivacaine for one hour) was started during labour and blood pressure remained normal. The second stage was augmented with oxytocin (6 mU/minute). Internal monitoring showed early (type I) and late (type II) decelerations. Five minutes before birth the pH of the scalp blood was 7-31. The infant's head was delivered easily by ventouse but the neck was tightly entangled by two loops of cord. Because the nuchal cord could not be reduced early clamping and cutting were necessary for full delivery. Apgar scores were 4 and 6 after one and five minutes, respectively. The umbilical arterial pH was 7 05.
P. (1972). Archives of Disease in Childhood, 47, 639. Significance of the single umbilical artery: a clinical, radiological, chromosomal, and dermatoglyphic study. A single umbilical artery is present in about 1% of all singletons. It is associated with a wide range of congenital malformations. Chromosomal analysis of our surviving cases gave normal results. Dermatoglyphic patterns were normal, except that the boys showed a three-to fourfold increase in the number of the radial loops on the fingers, and a lowering of the total finger ridge count. Evidence favouring a common non-genetic cause for both a single umbilical artery and the associated malformations is discussed.Although the absence of one umbilical artery was first reported a century ago (Hyrtl, 1870), the significance of a single umbilical artery (SUA) has only been realized since a retrospective study by Benirschke and Brown (1955) showed it was associated with increased incidence of congenital anomalies. Because most of the investigations on SUA have been made by pathologists, the conclusions drawn may not be applicable to the live infant population. And because most of these studies are retrospective, they may also be biased with respect to the incidence of congenital malformations.The present report concerns a prospective study carried out in a consecutive series of 2572 singletons born in the same hospital and followed up over a period of several years by means of a planned investigative programme including intravenous pyelography (IVP), chromosome patterns, and dermatoglyphs. MethodsIn this investigation the umbilical cord was studied in various ways: gross examination of the freshly delivered umbilical cord and placenta; re-examination after fixation for one week in 10% formaldehyde, followed by the study of H. and E.-stained paraffin sections prepared from the middle portion of the cord.All children with SUA who succumbed during the perinatal period were necropsied. Follow-up study of the survivors included clinical examination, IVP, and Received 13 December 1971. investigation of the karyotype and dermatoglyphs.The mean age at the last examination was 21 months (range, 5 months to 31 years). ResultsIncidence and mortality. In 29 of the 2572 consecutive cords examined (1-1 %), one umbilical artery was lacking. The significance of SUA, and its association with such factors as birthweight, maternal pathology, and placental pathology have been discussed elsewhere (de Clercq et al., 1970).Of the 29 children with SUA, 4 were stillborn and 2 died neonatally, giving a perinatal mortality rate of 21%. Half of the stillborn fetuses (2/29: 7%) showed congenital malformations (Table I).Of the 23 children with SUA still living, 22 were given a complete clinical and neurological examination. In one case examination was refused by the parents; this child had been found to be grossly normal at birth and showed no malformations at
The relationship between low social class and low birthweight or preterm deliveries is well established in singletons but not in twins. We present a study using all twin deliveries registered in Belgium in 1983 and in Aberdeen between 1951 and 1983. No significant relationship was found between social class and low birthweight, very low birthweight or preterm deliveries in the Belgian sample. In Aberdeen, we found significantly higher rates of low birthweight twins in low social classes. This increase of low birthweight twins in low social classes occurred in Aberdeen during the period 1951-1968, but not in the more recent data.
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