Figure - available from: International Journal of Women's Health
This content is subject to copyright. Terms and conditions apply.
Sagittal image of breech-presenting fetus at 27 weeks’ gestation. Upper panel: Power Doppler image of quadruple nuchal cord. Lower panel: Power Doppler three-dimensional image of above. Note coiled nuchal cords. Reproduced with permission from Sherer DM, Dalloul M, Sabir S, London V, Haughton M, Abulafia O. Persistent quadruple nuchal cord throughout the third trimester associated with decelerating fetal growth. Ultrasound Obstet Gynecol. 2017;49(3):409–410. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.87
Source publication
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 i...
Similar publications
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 con...
Citations
... The predisposing cause of the nuchal cord could be the uterine, fetal, and/or umbilical cord biometrics, such as length of the umbilical cord, volume of placental and amniotic fluid, and fetal movement in the uterus (1). Sherer et al. (6) reported that excessively long umbilical cords, polyhydramnios, and excessive fetal movement may be the leading cause of the nuchal cord. Nuchal cord in humans can be diagnosed by ultrasonic examination, and necessary measures could be taken according to the type of nuchal cord and length of gestation. ...
The umbilical cord acts as the critical lifeline of the developing fetus by providing nutrients and oxygen to it. Umbilical cord abnormalities are considered the leading cause of stillbirth in humans, but information on stillbirths associated with umbilical cord abnormalities is very scant in the clinical practice of animals. Here, we described a case of fetal demise in camels indicated to be caused by fetal death from strangulation by its umbilical cord, which is commonly known as the nuchal cord. A pregnant camel at its 36 weeks of gestation spontaneously aborted a single fetus. The camel was 5 years old and nullipara. A 6-day-old cloned embryo was transferred transcervically to the recipient. Pregnancy was confirmed 50 days after embryo transfer by ultrasonography, and the pregnant camel was maintained under a standard nutritional plan. The neck of the aborted fetus was strangulated tightly by a double loop of the umbilical cord. There was no congenital anomaly or other malformation in the fetus. We concluded that the nuchal cord was tightly coiled around the neck of the fetus and interfered with the blood flow in the fetus by collapsing the umbilical vein and subsequently causing fetal death and abortion. To the authors' knowledge, this is the first reported case of a nuchal cord in camels.
... In contrast, they comprise about 33% of stillbirths in the third trimester. 4 It remains unclear why some fetuses develop nuchal cords while some do not. Known risk factors include excessively long umbilical cords, male fetuses and primiparity. ...
... 5 The incidence of nuchal cords with multiple loops is less than 5% and decreases further with higher numbers of loops. 4 The following case describes a caesarean delivery in which a nuchal cord with eight loops was noted following emergent preterm caesarean delivery in the setting of growth restriction and non-reassuring fetal monitoring. ...
... Fetal distress due to nuchal cords is thought to be acute in nature and has been described in 33% of third trimester stillbirths. 4 Thus, the ultimate decision for iatrogenic preterm delivery was made based on persistent non-reassuring fetal status, not the presence of nuchal cord or fetal growth restriction. ...
Nuchal cord accidents comprise a third of stillbirths in the third trimester. These are often due to higher order nuchal cords, with more than three loops. In this report, we discuss a case of a gestation complicated by a nuchal cord with eight loops and severe fetal growth restriction, requiring expedited delivery due to non-reassuring fetal heart tones. Our case demonstrates the value of high-quality ultrasound in detecting complex nuchal cords, as well as highlighting the potentially dynamic and unstable fetal status in an affected gestation. Antenatal knowledge of nuchal cord in the setting of non-reassuring fetal status can help guide patient counselling and assist with identifying possible aetiologies. Finally, our case demonstrates that close monitoring and early intervention can prevent potentially catastrophic outcomes.
... Various manifestations of umbilical cord entanglement, namely nuchal cord(s), true knot(s), and complex entanglement of the umbilical cord, have been presented in detail in earlier separately published commentaries in the Journal, and hence, although involving the umbilical cord per se, various manifestations of umbilical cord entanglement and arterial or venous Doppler assessments will not be addressed in this commentary. [12][13][14] ...
... For detailed prenatal sonographic assessments and suggested management regarding each of these separate entities, the reader is referred to three recently published Commentaries in the Journal. [12][13][14] An interesting observation is the direct association between the length of umbilical cord and degree (number of nuchal cord loops, true knots and coverall complex umbilical cord entanglement). Also of interest is the possible association of an increased risk of fetal growth restriction associated with excessively long umbilical cords, 19,20 and reported fetal thrombotic vasculopathy, which has been reported to predispose the placenta to marked fetal thrombotic vasculopathy. ...
... In a report of 14 such cases, Weissman-Brenner et al noted a median gestational age of 27.5 weeks' gestation at diagnosis (range: [22][23][24][25][26][27][28][29][30][31][32][33][34]. 189 The average diameter of the varix was 10.6 mm (range: [8][9][10][11][12][13][14][15], and maximal diameter at follow-up was 12.8 mm (range: 10-18 mm). Median gestational age at delivery was 36.1 weeks (range 34-40) average birth weight was 2834 grams (range 1725-3715 grams). ...
The umbilical cord constitutes a continuation of the fetal cardiovascular system anatomically bridging between the placenta and the fetus. This structure, critical in human development, enables mobility of the developing fetus within the gestational sac in contrast to the placenta, which is anchored to the uterine wall. The umbilical cord is protected by unique, robust anatomical features, which include: length of the umbilical cord, Wharton’s jelly, two umbilical arteries, coiling, and suspension in amniotic fluid. These features all contribute to protect and buffer this essential structure from potential detrimental twisting, shearing, torsion, and compression forces throughout gestation, and specifically during labor and delivery. The arterial components of the umbilical cord are further protected by the presence of Hyrtl’s anastomosis between the two respective umbilical arteries. Abnormalities of the umbilical cord are uncommon yet include excessively long or short cords, hyper or hypocoiling, cysts, single umbilical artery, supernumerary vessels, rarely an absent umbilical cord, stricture, furcate and velamentous insertions (including vasa previa), umbilical vein and arterial thrombosis, umbilical artery aneurysm, hematomas, and tumors (including hemangioma angiomyxoma and teratoma). This commentary will address current perspectives of prenatal sonography of the umbilical cord, including structural anomalies and the potential impact of future imaging technologies.
... Should delivery be considered? And if so, at what gestational age? [48][49][50] In our unit in an inner-city teaching hospital, we are simply unwilling to withhold the potentially critical prenatal diagnosis of complex umbilical cord entanglement from our patients, as others have proposed/inferred. [51][52][53] We therefore uniformly inform our patients of this condition in real-time upon diagnosis, irrespective of gestational age. ...
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.
... In this study, we selected the term pregnant women with UCAN, and found that DFMC can reliably predict the safety of the fetus with UCAN in the uterus before delivery. In comparison of the two groups, AFI was not signi cant, and the results were not consistent with those of previous studies [17,18,19] which were positive correlation between AFI and fetal safety in uterus, and this reason may be related to the inconsistent criteria for inclusion of pregnant women without any clear prenatal risk factors. In this study, we found that the fetal intrauterine safety may be related to the loops of UCAN, DFMC, modi ed Fischer score (NST), S/D and mode of delivery by comparison of the prenatal factors. ...
Background
Currently, FM is a sole subjective index which depends on self-assessment of pregnant women, and it can objectively reflect the well being of intrauterine fetus. It has been the focus of obstetricians' research and attention how to quantify fetal movement (FM) and change it into a relatively objective evaluation index. We sought to predict and evaluate the well being of intrauterine fetal with umbilical cord around the neck (UCAN) by performance of daily fetal movement counting chart (DFMC).
Methods
To retrospectively select 100-case pregnant women who met the enrolled requirements, and whether the fetal was intrauterine safety or not was predicted by analysis of the DFMC before delivery. According to the different perinatal outcomes after delivery, 100-cases pregnant women were divided into intrauterine safety (IUS) group (44 cases) and intrauterine unsafe (IUNS) group (56 cases). And the independent risk factors of fetal intrauterine safety, including maternal age, gestational week, umbilical artery systolic blood flow to diastolic blood flow ratio (S/D), amniotic fluid index (AFI), modified Fischer score of non stress test (NST), DFMC and mode of delivery were analyzed by multi-factors Binary Logistic Regression.
Results
Only FM and mode of delivery were independent risk factors affecting fetal safety intrauterine (all p value < 0.05). There was no remarkable difference between DFMC prediction and clinical retrospective evaluation of fetal safety in natural delivery and forceps delivery (all P value > 0.05), except in cesarean section (p < 0.05). The sensitivity, specificity and Yuden index of DFMC for predicting the intrauterine safety in natural vaginal delivery were 86.5%, 90.0% and 0.77 respectively, and in cesarean section were 66.7%, 94.6% and 0.61, respectively. Abnormal DFMC may account for the highest proportion of emergency cesarean section (87.5%, 35/40).
Conclusions
DFMC can effectively predict and evaluate the well being of intrauterine fetus with UCAN. At the same time, it can also provide limited clinical proofs for pregnant women with UCAN to choose model of delivery.
BACKGROUND
By comprehensively analyzing the blood flow parameters of the umbilical and middle cerebral arteries, doctors can more accurately identify fetal intrauterine distress, as well as assess its severity, so that timely interventions can be implemented to safeguard the health and safety of the fetus.
AIM
To identify the relationship between ultrasound parameters of the umbilical and middle cerebral arteries and intrauterine distress.
METHODS
Clinical data of pregnant women admitted between January 2021 and January 2023 were collected and divided into the observation and control groups (n = 50 each), according to the presence or absence of intrauterine distress. The ultrasound hemodynamic parameters of the uterine artery (UtA), fetal middle cerebral artery (MCA), and umbilical artery (UmA) were compared with neonatal outcomes and occurrence of intrauterine distress in the two groups.
RESULTS
Comparison of ultrasonic hemodynamic parameters, resistance index (RI), pulsatility index (PI), and systolic maximal blood flow velocity of UmA compared to diastolic blood flow velocity (S/D), revealed higher values of fetal MCA, PI, and S/D of UmA in pregnant women with UtA compared to controls (P < 0.05), while there was no difference between the two groups in terms of RI (P < 0.05) The incidence of a neonatal Apgar score of 8-10 points was lower in the observation group (66.7%) than in the control group (90.0%), and neonatal weight (2675.5 ± 27.6 g) was lower than in the control group (3117.5 ± 31.2 g). Further, cesarean section rate was higher in the observation group (70.0%) than in the control group (11.7%), and preterm labor rate was higher in the observation group (40.0%) than in the control group (10.0%). The incidence of fetal distress, neonatal growth restriction and neonatal asphyxia were also higher in the observation group (all P < 0.05).
CONCLUSION
Fetal MCA, UmA, and maternal UtA hemodynamic abnormalities all develop in pregnant women with intrauterine distress during late pregnancy, which suggests that clinical attention should be paid to them, and monitoring should be strengthened to provide guidance for clinical intervention.
