[Umbilical cord entanglement and color-coded Doppler ultrasound]

The incidence of umbilical cord entanglement is about 20-33%. The present study describes the antepartal detection of nuchal cord using Colour Doppler sonography. In 137 cases, the identification of cord entanglement through a high resolution real-time Colour Doppler equipment (Picker 192/Acuson 128 XP) was achieved with sensitivity of 97%, the positive predictive value was 89%, the negative predictive value 96% and the efficiency 93%. In complicated cases, the pulsed Doppler sonography of the cord vessels provided significant differential diagnostic evaluation (Aa. and V. umbilicales vs. uteroplacental vessels). The use of this new method is especially indicated in situations with uncertain variable decelerations and/or other abnormal findings in the antepartal FHR-registration. The early recognition of a nuchal cord could possibly prevent serious peri-/subpartal complications in many cases. The result of our investigations suggest, that once a cord entanglement has been identified sonographically, the antepartal cardiotocography, sonography, Doppler flow examination and intrapartal foetal monitoring should be more frequently and intensively performed.