Cord around the_neck

NUCHAL CORD

Cord around the fetal neck....... A Review and

approach.

MERCURY IMAGING INSTITUTE SCO 172-173 SEC 9C CHANDIGARHMERCURY IMAGING CENTRE SCO 16-17 SEC 20D CHANDIGARH

Nuchal cord ................

• Nuchal cord is present in one-fourth of pregnancies but generally doesn’t has major clinical significance.

• The presence of two or more loops is estimated to affect between 2.5% to 8.3% of all pregnancies.

• Single loop of nuchal cord usually does not compromise fetal well-being, and thus does not alter standard management.

• Multiple nuchal cords, especially four or more loops, demand special care due to the risk of intermittent cord compression.

Hippocrates described in the “De Octimestri Partu” the nuchal and chest coiling of the umbilical cord, and regarded it as “one of the dangers of the eighth month”. He also stated that when the nuchal cord persists until the term of pregnancy, it will cause suffering to the mother and either perish or born difficulties to the fetus.

History....................

• Type A -Nuchal loop that encircles the neck in a freely sliding pattern . This loop can undo itself.

Giacomello classified the nuchal cord into two types

Type B - Nuchal loop that encircles the neck in a locked pattern .

Type B cannot undo itself.

Giacomello classified the nuchal cord into two types

NUCHAL CORD – SINGLE LOOP

NUCHAL CORD – SINGLE LOOP

The recognition of a single loop relies on the demonstration of a section of cord between the head and shoulder in a sagittal section, and the demonstration of a complete loop in an axial section of the neck. This is often difficult because of shadowing, and a compound image is often required.

SAGITTAL AND CORONAL PLANE TO ASSESS FOR NUCHAL CORD

NUCHAL CORD – SINGLE LOOPAXIAL IMAGE ON FETAL MR .

NUCHAL CORD – SINGLE LOOPSAGITTAL PLANE ON FETAL MR.

NUCHAL CORD – SINGLE LOOPSAGITTAL PLANE ON FETAL MR.

APPRECIATE THREE VESSEL CORD.

THREE VESSEL CORD

AN APPROACH TO ASSESS NUCHAL CORD.

Nuchal cord :Single loopMultiple loop Sliding type Locking type

Axial and sagittal image planes are important . Divergent ends of the cord are suggestive of sliding pattern .Color doppler assesment of the cord helps to characterize the nuchal cord better .Look for signs of fetal distress , meconium staining, variable cardiac deceleration