Nuchal cord: impact of umbilical artery Doppler indices on intrapartum and neonatal outcomes: a prospective cohort study

Abdallah, Ameer; El-Dorf, Ayman; Sallam, S; Ahmed, Sonia; Shawky, Mohamed; Nawara, Maii; Elsayed, Mohamed A.; Islam, Ba; Abdelrahman, Rehab M.; Sabaa, Haitham M.; Bahaaeldin, Ahmed Mohamed; Yehia, Ahmed; Rateb, Ahmed; Sakna, Noha A.; Mamdouh, Ahmed; Taema, Mohammed; Elshourbagy, Maged M; Alanwar, Ahmed

doi:10.1080/14767058.2018.1463984

Cited by 8 publications

(6 citation statements)

References 29 publications

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“…For this element, a positive index test result was any nuchal cord suspected antenatally using ultrasound and the reference standard was the presence of a nuchal cord at birth. Results were combined for ultrasound screening at any gestation; four studies [ 7 , 30 – 32 ] performed screening immediately prior to induction or during labour and in all but two studies all measurements were performed after 36 weeks [ 33 , 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…On the basis of this information identifying an isolated nuchal cord antenatally is unlikely to prevent adverse outcome, but may increase intervention. However, combining identification of nuchal cord and abnormal umbilical artery flow increases the likelihood of intrapartum compromise [ 7 , 59 ]. Further test-accuracy studies are needed, but must be appropriately blinded to prevent intervention altering the outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Of the possible reported UCA, nuchal cord, where the umbilical cord is wound at least once around the fetal neck [2], has been the subject of the most studies; its incidence increases throughout gestation, peaking at birth [3,4]. While there are reports of nuchal cord in individual cases of stillbirth [5], data from larger studies are conflicting, with some finding significant associations [5,6] and others reporting no effect of nuchal cord on stillbirth [7,8]. Other UCA, including true knots and cord prolapse are rarer, but are also linked to adverse outcomes; cohort studies have demonstrated associations between true knots and perinatal death and between cord prolapse and low Apgar scores [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Umbilical cord characteristics and their association with adverse pregnancy outcomes: A systematic review and meta-analysis

et al. 2020

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Objective Current data on the role of the umbilical cord in pregnancy complications are conflicting; estimates of the proportion of stillbirths due to cord problems range from 3.4 to 26.7%. A systematic review and meta-analysis were undertaken to determine which umbilical cord abnormalities are associated with stillbirth and related adverse pregnancy outcomes. Methods MEDLINE, EMBASE, CINAHL and Google Scholar were searched from 1960 to present day. Reference lists of included studies and grey literature were also searched. Cohort, cross-sectional, or case-control studies of singleton pregnancies after 20 weeks' gestation that reported the frequency of umbilical cord characteristics or cord abnormalities and their relationship to stillbirth or other adverse outcomes were included. Quality of included studies was assessed using NIH quality assessment tools. Analyses were performed in STATA. Results This review included 145 studies. Nuchal cords were present in 22% of births (95% CI 19, 25); multiple loops of cord were present in 4% (95% CI 3, 5) and true knots of the cord in 1% (95% CI 0, 1) of births. There was no evidence for an association between stillbirth and any nuchal cord (OR 1.11, 95% CI 0.62, 1.98). Comparing multiple loops of nuchal cord to single loops or no loop gave an OR of 2.36 (95% CI 0.99, 5.62). We were not able to look at the effect of tight or loose nuchal loops. The likelihood of stillbirth was significantly higher with a true cord knot (OR 4.65, 95% CI 2.09, 10.37).

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Umbilical cord characteristics and their association with adverse pregnancy outcomes: A systematic review and meta-analysis

et al. 2020

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“…With the development of embryos during normal pregnancy, placental trophoblast cells infiltrate continuously, UtA vascular remodelling is strengthened, the lumen is continuously enlarged, and the elasticity of the vascular wall is reduced. Uterine blood flow changes to low resistance and high flow rate from the high resistance and low flow rate before pregnancy [ 28 – 30 ]. The placental trophoblasts of pregnant women with HDCP have insufficient ability to infiltrate the arteries, the strength and quantity of vascular remodelling are also insufficient, the muscle layer of the vascular wall still maintains a large elasticity, and the vascular resistance goes up.…”

Section: Resultsmentioning

confidence: 99%

Fetal and Neonatal Middle Cerebral Artery Hemodynamic Changes and Significance under Ultrasound Detection in Hypertensive Disorder Complicating Pregnancy Patients with Different Severities

Zhou¹,

Sun²,

Tan³

et al. 2022

Computational and Mathematical Methods in Medicine

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Colour Doppler ultrasound was applied for monitoring the hemodynamic parameters of fetal uterine artery (UtA), umbilical artery (UA), and middle cerebral artery (MCA) during pregnancy. In hypertension disease complicating pregnancy, these hemodynamic measures and their therapeutic applicability value were reviewed (HDCP). 120 singleton pregnant women were chosen, with 40 cases of mild preeclampsia (mild group), 40 cases of severe preeclampsia (severe group), and 40 normal control pregnant women (control group). The hemodynamic parameters of UtA, MCA, and UA were monitored in the three groups, including pulsatility index (PI), resistance index (RI), and the systolic/diastolic velocity (S/D). The parameters PI, RI, S/D, and venous catheter shunt rate (Qdv/Quv) of UtA and UA in the severe group were higher than those in the normal group and the mild group, showing the differences statistically significant ( P < 0.05 ). The PI, RI, and S/D of MCA in the severe group were lower than those in the normal group and the mild group ( P < 0.05 ). The changing trends of PI, RI, and S/D in the severe group were all first increased and then decreased in the early, middle, and later pregnancy ( P < 0.05 ). The area under the curve (AUC) was 0.98 in the receiver operating characteristic (ROC) curve created using a combination of hemodynamic measures and pregnancy outcomes, and the sensitivity and specificity for predicting bad outcomes were 94.7 percent and 96.4 percent, respectively. Colour Doppler ultrasound may accurately detect changes in the PI, RI, and S/D of UtA, MCA, and UA in pregnant women and serve as a reference for determining the intrauterine state of the fetuses and predicting bad pregnancy outcomes. In particular, the parameters in later pregnancy were higher worthy of diagnostic value for adverse pregnancy outcomes. The combination of various parameters could make an improvement of the diagnostic accuracy and provide a basis for guiding treatment as well as determining the optimal timing of delivery.

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“…Twenty studies evaluated the UA,10–29 and seven reported its predictive values for FGR. The PPV for FGR reported in the individual studies were between 77.40 and 88.5,11 16 21 24 while the area under the receiver operating characteristic (AU ROC) curve was 0.63,17 mostly in high-risk pregnancies.…”

Section: Resultsmentioning

confidence: 99%

Prognostic accuracy of antenatal Doppler ultrasound for adverse perinatal outcomes in low-income and middle-income countries: a systematic review

et al. 2021

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ObjectivesThis systematic review examined available literature on the prognostic accuracy of Doppler ultrasound for adverse perinatal outcomes in low/middle-income countries (LMIC).DesignWe searched PubMed, Embase, Cochrane Library and Scopus from inception to April 2020.SettingObservational or interventional studies from LMICs.ParticipantsSingleton pregnancies of any risk profile.InterventionsUmbilical artery (UA), middle cerebral artery (MCA), cerebroplacental ratio (CPR), uterine artery (UtA), fetal descending aorta (FDA), ductus venosus, umbilical vein and inferior vena cava.Primary and secondary outcome measuresPerinatal death, stillbirth, neonatal death, expedited delivery for fetal distress, meconium-stained amniotic fluid, low birth weight, fetal growth restriction, admission to neonatal intensive care unit, neonatal acidosis, Apgar scores, preterm birth, fetal anaemia, respiratory distress syndrome, length of hospital stay, birth asphyxia and composite adverse perinatal outcomes (CAPO).ResultsWe identified 2825 records, and 30 (including 4977 women) from Africa (40.0%, n=12), Asia (56.7%, n=17) and South America (3.3%, n=01) were included. Many individual studies reported associations and promising predictive values of UA Doppler for various adverse perinatal outcomes mostly in high-risk pregnancies, and moderate to high predictive values of MCA, CPR and UtA Dopplers for CAPO. A few studies suggested that the MCA and FDA may be potent predictors of fetal anaemia. No randomised clinical trial (RCT) was found. Most studies were of suboptimal quality, poorly powered and characterised by wide variations in outcome classifications, the timing for the Doppler tests and study populations.ConclusionLocal evidence to guide how antenatal Doppler ultrasound should be used in LMIC is lacking. Well-designed studies, preferably RCTs, are required. Standardisation of practice and classification of perinatal outcomes across countries, following the international standards, is imperative.PROSPERO registration numberCRD42019128546

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Nuchal cord: impact of umbilical artery Doppler indices on intrapartum and neonatal outcomes: a prospective cohort study

Abstract: In view of these results, it might be concluded that umbilical cord tightness affecting fetal hemodynamics (expressed by changes in umbilical artery Doppler) might be a determinate factor affecting the intrapartum course.

Cited by 8 publications

References 29 publications

Umbilical cord characteristics and their association with adverse pregnancy outcomes: A systematic review and meta-analysis

Umbilical cord characteristics and their association with adverse pregnancy outcomes: A systematic review and meta-analysis

Fetal and Neonatal Middle Cerebral Artery Hemodynamic Changes and Significance under Ultrasound Detection in Hypertensive Disorder Complicating Pregnancy Patients with Different Severities

Prognostic accuracy of antenatal Doppler ultrasound for adverse perinatal outcomes in low-income and middle-income countries: a systematic review

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