Is fetal cerebral vascular resistance affected by the presence of nuchal cord(s) in the third trimester of pregnancy?

Sherer, David M.; Sokolovski, Margarita; Dalloul, Mudar; Khoury‐Collado, Fady; Abulafia, Ovadia

doi:10.1002/uog.1874

Cited by 15 publications

(11 citation statements)

References 20 publications

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“…In our prospective study of a set of 115 patients with well-established dates and singleton, appropriate for gestational age, nonanomalous fetuses between 28 and 41 weeks' gestation and nuchal cord(s) (103 fetuses with a single loop and 12 a double nuchal cord), we later performed an analysis of outcomes according to the presence or absence of coiling within the nuchal cord(s) at the time of prenatal sonographic diagnosis. 78 No significant differences in perinatal outcomes were noted, although it should be mentioned that this subset analysis did not reach statistical power to substantiate this negative finding.…”

Section: Decreased Umbilical Cord Coilingmentioning

confidence: 76%

Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of Nuchal Cord(s)

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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Section: Decreased Umbilical Cord Coilingmentioning

confidence: 76%

Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of Nuchal Cord(s)

Sherer¹,

Ward²,

Bennett³

et al. 2020

IJWH

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“…33 A healthy newborn was delivered by Cesarean at 33 and 1/7 weeks' gestation with the presence of a true knot confirmed at delivery. 32 In contrast to single nuchal cords, which occur in between 15.8% and 30% of singleton fetuses at term, and have not been unequivocally associated with significant adverse perinatal outcome, 6,20,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] true knot(s) of the umbilical cord occur in 0.04% to 3% of deliveries, and have been associated with perinatal morbidity in 11% of cases, and a notable 4 to10 fold increase in stillbirth. 28,29,[53][54][55][56][57][58][59][60][61][62] Although (multiple) true knots of the umbilical cord have been infrequently implicated with fetal growth restriction, a causal association remains unproven.…”

Section: True Knot(s) Of the Umbilical Cordmentioning

confidence: 99%

Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of True Knot of the Umbilical Cord

Sherer

Amoabeng

Dryer

et al. 2020

IJWH

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Umbilical cord accidents preceding labor are rare. Single and multiple nuchal cords, and true knot(s) of the umbilical cord, are often incidental findings noted at delivery of nonhypoxic non-acidotic newborns without any evidence of subsequent adverse neonatal outcome. In contrast to single nuchal cords, true knots of the umbilical cord, which occur in between 0.04% and 3% of all deliveries, have been associated with a reported 4 to 10 fold increased risk of stillbirth. First reported with real-time ultrasound, current widespread application of color Doppler, power Doppler and three-dimension sonography, has enabled increasingly more accurate prenatal sonographic diagnoses of true knot(s) of the umbilical cord. Reflecting the inability to visualize the entire umbilical cord at prenatal ultrasound assessment, despite detailed second and third-trimester scanning, many occurrences of incidental true knot of the umbilical cord remain undetected and are noted only at delivery. Although prenatal sonographic diagnostic accuracy is increasing, false positive sonographic diagnosis of true knot of the umbilical cord cannot be ruled out with certainty, and must continue to be considered clinically. Notwithstanding the inability to diagnose all true knots, currently there is a clear absence of clinical management guidelines by governing bodies regarding patients in whom prenatal sonographic diagnosis of true knot(s) of the umbilical cord is / are suspected. As a result, in many prenatal ultrasound units, suspected sonographic findings suggestive of or consistent with true knot of the umbilical cord are often disregarded, not documented, and patients are not uniformly informed of this potentially life-threatening condition, which carries an associated considerable risk of stillbirth. This commentary will address current perspectives of prenatal sonographic diagnostic and management challenges associated with true knot(s) of the umbilical cord in singleton pregnancies.

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“…Although the umbilical cord has been studied extensively, investigators have not been able to demonstrate PI modifications in fetuses with NC during the third trimester14, 15. Some authors have studied its usefulness in improving the calculation for aneuploidy risk during the first trimester16 by relating the umbilical cord diameter to the risk of chromosomal anomalies17.…”

Section: Discussionmentioning

confidence: 99%

Influence of nuchal cord on ductus venosus assessment at 11 to 13 + 6 weeks' gestation

Plasencia

López

Esparza

et al. 2010

Ultrasound in Obstet & Gyne

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Is fetal cerebral vascular resistance affected by the presence of nuchal cord(s) in the third trimester of pregnancy?

Abstract: Objective To assess whether fetal cerebral vascular resistance is affected by the presence of nuchal cord(s) in the third trimester. Methods

Cited by 15 publications

References 20 publications

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

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

<p>Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of True Knot of the Umbilical Cord</p>

Influence of nuchal cord on ductus venosus assessment at 11 to 13 + 6 weeks' gestation

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