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Nuchal cord and its implications.

Morarji Peesay1

  • 1Department of Pediatrics Division of Neonatal Perinatal Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Rd, NW; Suite M3400, Washington, DC 20007 USA.

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Summary

Nuchal cords, umbilical cords wrapped around a fetus's neck, can cause complications if tight. This review explores the pathophysiology of tight nuchal cords and identifies research gaps.

Keywords:
Adult strangulationNuchal cordsPartial prolonged asphyxiaTight Nuchal cord around the neck syndrome (tCAN syndrome)

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Area of Science:

  • Perinatology
  • Fetal Medicine
  • Neonatology

Background:

  • Nuchal cords, occurring in 10-29% of fetuses, involve the umbilical cord wrapping around the fetal neck.
  • While often benign, tight nuchal cords can lead to adverse perinatal outcomes and potential long-term infant effects.
  • The pathophysiology of tight nuchal cords shares similarities with strangulation, impacting fetal blood flow and oxygenation.

Purpose of the Study:

  • To review the pathophysiology of tight nuchal cords.
  • To explore existing knowledge gaps.
  • To identify areas for future research.

Main Methods:

  • Literature review of existing studies on nuchal cords.
  • Analysis of pathophysiological mechanisms.
  • Identification of clinical and research challenges.

Main Results:

  • Tight nuchal cords can cause umbilical cord compression, obstructing blood flow.
  • Compression can lead to fetal hypovolemia, acidosis, and anemia.
  • Infants with tight nuchal cords may exhibit distinct physical features compared to those with birth asphyxia.

Conclusions:

  • Tight nuchal cords represent a distinct clinical entity with specific pathophysiological consequences.
  • Further research is needed to fully understand the long-term effects and optimal management strategies.
  • Clarifying the pathophysiology can improve diagnostic accuracy and clinical care for affected neonates.