UMBILICAL-CORD ENTANGLEMENT AND COLOR DOPPLER SONOGRAPHY

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.