1. Dilemmas in the management of nuchal cord Amita Suneja Professor UCMS & GTBH

4. Dilemmas

5. Nuchal cord & Asphyxia

6. Diagnosis of nuchal cord Nuchal cord- 360 degree around the neck Ultrasonic diagnosis in Antenatal period 2D USG / Doppler / 3D USG Diagnostic criteria Diagnostic accuracy : 35% - 80% Can diagnose multiple loops: 2%(two loops) & 0.2% (> 2loops) CAN NOT differentiate between tight & loose cord

8. Behaviour of nuchal cord during ANP Nuchal Cords appear & disappear Rare before 20 weeks Incidence increases as gestation increases

9. Whether or not nuchal cords are associated with significantly increased adverse fetal outcome ? Monoamniotic twins

10. Retrospective studies

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

15. Apgar <7 at 1’ was more in nuchal gp but at 5’ was not differentNOT associated with adverse Perinatal outcome

16. Prospective double blind studies Eur J Obstet Gynecol Repr Biol 2005 352, Vx, SLF, 37-39 weeks USG 38 weeks Sens & spec: 85 & 89% NOT associated with abnormal intra partum CTG / clinically significant Apgar score Nullipara with nuchal cord had higher incidence of LSCS (18%) Obstet Gynecol 2005 289 women USG just before induction Sens: 37% 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

17. Nuchal cord & feal acidosis

19. Can nuchal cord be cause of still birth? Int J Obstet Gynecol 2000: 98 SB (84 AP + 14 IP) Nuchal cord (single or multiple) is insufficient evidence to explain Do complete work up of SB Autopsy HPE of UC & placenta

20. Summary

21. Food for thought

22. THANK YOU