After B-ultrasound, A common problem troubling expectant mothers is the umbilical cord around the neck. Because some people (including some obstetricians and gynecologists) will say, Umbilical cord around neck is dangerous, Better have a cesarean section, If you give birth by yourself, you will have serious adverse consequences such as intrauterine hypoxia and asphyxia. This statement makes many expectant mothers at a loss. Feel anxious, because not only the Internet is saying, friends around you are saying, even some obstetricians and gynecologists are saying so. For this kind of rumor, everyone’s mentality is often to believe it rather than believe it. It is really an old saying: no one believes the truth, fallacies spread thousands of miles! In order to ease everyone’s worries, I will make another rumor mill.
The English equivalent of umbilical cord around neck is Nuchal Cord, Also known as Cord Around Neck (CAN), some hospitals take the so-called ambiguous attitude towards umbilical cord around the neck, that is, they do not write Chinese on the ultrasound report, but only write the abbreviation CAN for doctors to see. If it is around the neck, write CAN1, write CAN2 around the neck, and so on. In fact, umbilical cord around the neck does not want to be so terrible as the legend. The following is the conclusion of the latest authoritative literature abroad:
1. Umbilical cord around the neck is very common. It can be wound around the neck once, several times, loose or tight. In all pregnant women, the incidence rate of umbilical cord around the neck is about 15-30%. The umbilical cord can be wound around the neck of the fetus at any time. After winding, it may exist continuously or come out at any time.
2. A large amount of evidence suggests that umbilical cord wrapping around the neck does not significantly increase the adverse prognosis of the fetus or newborn. Only a few case reports believe that umbilical cord wrapping around the neck is related to the adverse prognosis of the fetus and newborn. However, these reports are often retrospective and the number of cases is relatively small, so the evidence is insufficient.
3. It is generally not recommended to screen the umbilical cord around the neck during pregnancy. Even if the umbilical cord around the neck is found during ultrasound examination, it will not be written into the ultrasound report. If the patient asks, he can tell that the umbilical cord around the neck is a common phenomenon and will usually eliminate it by himself. Even if it persists, it will not significantly increase the adverse pregnancy outcome.
Therefore, our hospital no longer describes the umbilical cord around the neck in the ultrasound report, Because neck wrapping is very common, every 3-5 pregnant women will have one umbilical cord wrapping around the neck, and neck wrapping may occur or be eliminated at any time. We cannot carry out good monitoring and follow-up on umbilical cord wrapping around the neck. Now the examination does not see neck wrapping, how can you guarantee that neck wrapping will not occur tomorrow? How can you say that the fetus will not wrap around the neck today? Since umbilical cord around neck will not significantly increase the adverse outcome of fetus and newborn, why do you want to do it? How often should we follow up if we find out? How can we explain it to expectant mothers? If the explanation is not clear, it will increase the psychological burden of expectant mothers and the cesarean section rate. Why bother to waste people and money?
As mentioned earlier, prospective studies with a large sample size did not find that umbilical cord winding around the neck significantly increased the adverse outcome of the fetus and newborn, but retrospectively, a few cases reported that umbilical cord winding around the neck was related to the adverse prognosis of the fetus and newborn. Why is this happening? According to US statistics for 2005, The incidence of stillbirth is about 6 per thousand, The causes of stillbirth are many and complicated. If it’s just a gross autopsy, It is difficult to find out the real cause (about stillbirths, As one out of every three to five fetuses has an umbilical cord around the neck, Therefore, on the premise that the real reason cannot be found, the umbilical cord around the neck becomes the scapegoat. In most cases, the umbilical cord around the neck is wronged. Because if the umbilical cord around the neck is really the cause of the poor prognosis of the fetus and newborn as some people think, why can’t prospective studies confirm it? The main reason for the association of umbilical cord around the neck reported in small sample cases with poor prognosis of fetus and newborn (including stillbirth) should be concomitant relationship. Rather than causality, Because the incidence of umbilical cord around the neck is too high, In the event of stillbirth, The umbilical cord around the neck is easily used as an example. What is really related to the poor prognosis of the fetus and newborn is the true knot of the umbilical cord. However, the incidence rate of umbilical cord is very low, and the detection rate of ultrasound is not high, so the significance of screening is not big. Whether the umbilical cord is around the neck or not, in the third trimester of pregnancy, the doctor should carefully count the fetal movement according to the doctor’s advice, and the doctor will let you do fetal heart monitoring after labor, so as to find fetal distress and deal with it in time.
Now we should be able to understand why the latest foreign literature does not recommend routine screening of umbilical cord around the neck, even if the umbilical cord around the neck is found during ultrasound, it is not recommended to write the report.
The article was reprinted by Clove Garden authorized by the author.