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Case Study 4 - Prenatal Diagnosis Of A Double Nuchal Cord With A True Knot Resulting In Live Birth


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Case Report: 18 y/o G1P0 Received prenatal care starting at ten weeks. By 21 weeks cord entanglement was documented by ultrasound and tracked over time.

The patient was counseled regarding the ultrasound findings and instructed on fetal movement circadian rhythms. Being aware of fetal movements in 6hr internals, decreased movement or excessive movement was noted. At 39 wks fetal excessive movements occurred at bed time. The patient was monitored on L&D the next day and variables were noted suggesting cord compression. Maternal bedtime/sleep monitoring demonstrated fetal heart rated decelerations at 5am. Fig 1-2. Induction was decided due to the change in movement and fetal heart rate patterns. Beginning at 2cm, induction lasted 12 hrs. to 5cm.

Rupture of membranes showed clear fluid. An internal scalp fetal heart monitor showed gradual cord compression patterns. Tachycardia with heart arrythmia developed. A primary c/section was decided due to lack of cervical dilation past 5-6 cm for three hours and unresolved tachycardia with PAC's (in spite of fluids, repositioning, O2). Delivery documented a double nuchal cord with a waist loops (causing skin indentation) and a marginal umbilical cord placental insertion (posterior/caudad). Fig 3-5 A viable female infant was delivered and did well.


Figure 3 - Double Nuchal Cord


Figure 4 - Fetus at delivery showing partial rotation and waist loop


Figure 5 - Placental Marginal Insertion

The text "Silent Risk" documents two other similar cases with fetal heart arrythmia. Prolonged attempts at achieving vaginal delivery under similar circumstances may not be advisable.

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