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Dilemmas in the management of nuchal cord,[object Object],Amita Suneja,[object Object],Professor,[object Object],UCMS & GTBH,[object Object]
Dilemmas In The Management Of Nuchal Cord
Dilemmas In The Management Of Nuchal Cord
Dilemmas,[object Object]
Nuchal cord & Asphyxia,[object Object]
Diagnosis of nuchal cord,[object Object],Nuchal cord- 360 degree around the neck,[object Object],Ultrasonic diagnosis in Antenatal period,[object Object],2D USG / Doppler / 3D USG,[object Object],Diagnostic criteria,[object Object],Diagnostic accuracy : 35% - 80%,[object Object],Can diagnose multiple loops: 2%(two loops) &     0.2% (> 2loops),[object Object],CAN NOT differentiate between tight & loose cord,[object Object]
Dilemmas In The Management Of Nuchal Cord
Behaviour of nuchal cord during ANP,[object Object],Nuchal Cords appear & disappear ,[object Object],Rare before 20 weeks,[object Object],Incidence increases as gestation increases,[object Object]
   Whether or not nuchal cords are associated with significantly increased adverse fetal outcome   ?            ,[object Object],                     Monoamniotic twins,[object Object]
Retrospective studies,[object Object]
Prospective cross sectional studies,[object Object],KUMJ 2006,[object Object],[object Object]
   18% single loop, 3% multiple loops
   Abn FHR, MSL, instrumental delivery ↑ in   nuchal group but not significant
   LSCS were more in non nuchal gp
   Apgar <7 at 1’ was more in nuchal gp but at 5’ was not differentNOT associated with adverse Perinatal outcome,[object Object]
Prospective double blind studies,[object Object],Eur J Obstet Gynecol Repr Biol 2005,[object Object],352, Vx, SLF, 37-39 weeks,[object Object],USG 38 weeks,[object Object],Sens & spec: 85 & 89%,[object Object],NOT associated with abnormal intra partum CTG / clinically significant Apgar score,[object Object],Nullipara with nuchal cord had higher incidence of LSCS (18%),[object Object],Obstet Gynecol 2005,[object Object],289 women,[object Object],USG just before induction,[object Object],Sens: 37%,[object Object],No significant ↑ risk of LSCS  (35 Vs 28%, RR- 1.22; 95% CI0.08-1.8), ID for AFD, Abn FHR, Apgar &lt; 7 at 1’, UBA pH &lt; 7.1 or NICU admissions,[object Object]
Nuchal cord & feal acidosis,[object Object]
Dilemmas In The Management Of Nuchal Cord

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Dilemmas In The Management Of Nuchal Cord

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  • 12. 18% single loop, 3% multiple loops
  • 13. Abn FHR, MSL, instrumental delivery ↑ in nuchal group but not significant
  • 14. LSCS were more in non nuchal gp
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