Ultrasound in Diagnostics of Strangulation with Umbilical Cord

Introduction: Having in mind the significance of its function, umbilical cord represents one of the predictors of pregnancy outcome, delivery and vitality of the newborn . Umbilical cord is the only connection between fetus and source of oxygen and nutritional components, and ultrasound (especially color Doppler, pulsating Doppler and 3D) provide us with an insight into organic and functional changes in umbilical cord. Material and methods: We have analyzed medical histories of women who delivered in 2007, as well as their CTG records typical for complications with umbilical cord, ways of delivery and vitality of newborns. Results: Out of 3550 deliveries, in 801 changes which indicated complications with umbilical cord on CTG record were evident . Most commonly, we were dealing with short term compression of the convolute of cord loop(s) around neck, shoulder or body of the fetus or extension of short umbilical cord in the phase of expulsion . There were 27 urgent Cesarean sections which were performed due to acute and prolonged asphyxia which was caused by strangulation of the neck with umbilical cord and 2 cases of fetus mortus in utero – one case of term pregnancy with 5 loops around the neck and one case of 28 weeks pregnancy with 4 loops around fetal neck .Conclusion: Most commonly , strangulation with umbilical cord does not represent a significant obstetrical problem, but in some cases ( intensive fetal activity , beginning of contractions ) can lead to acute catastrophic conditions . According to the available literature, percentage of cases of strangulation with umbilical cord is around 24,6% in newborns , out of which 21% is with a single loop, 3,5% with 2 or three loops and 0,1 % with four or more loops . The maximum reported number of loops is nine. Frequency of loops depends on the length of the cord – with short cords (35cm) the incidence is 14%, with normal length cords–2,3% and with cords longer than 89cm -53%. Cord loops around fetal neck can easily be presented with B mode and color Doppler.