Fetal grasping of the umbilical cord and perinatal outcome.
This study assessed perinatal outcome in pregnancies with accidentally diagnosed fetal grasping of the umbilical cord (FGUC) on ultrasonography (US) in late gestation as a possible cause of fetal hypoxia due to mechanical occlusion of umbilical circulation. In this retrospective clinical study, routine antenatal US examination revealed FGUC from 32 to 41 weeks of gestation in seven normal single pregnancies. Upon FGUC findings, fetal condition was followed up every second day by repeat US findings of FGUC, and then by Doppler parameters of fetoplacental circulation measurement of resistance index in umbilical artery (URI) and middle cerebral artery (CRI), and cardiotocography (CTG), and perinatal outcome (peripartal cardiotocography, 5-min Apgar score, umbilical arterial blood pH, occurrence of meconium amniotic fluid, need of additional treatment at neonatal intensive care unit (NICU), and mode of pregnancy termination (cesarean section, forceps or vacuum extraction-VE for hypoxia). After delivery, neonatal neurosonography and neonatal complications related to pregnancy or birth were evaluated. All URI values were increased, resulting from persistent FGUC and elevated umbilical arterial RI. CRI showed great oscillations in the values for gestational age and decreased CRI. In two cases, cerebral/umbilical ratio was less than 1, indicating initial vasocentralization as a fetal compensatory mechanism for hypoxia. In these cases, a pathological peripartal CTG and pH 7.23, indicative of preacidosis, were verified. All children were discharged from NICU as healthy, free from neurological lesions, with the exception of the latter, who had dystonia syndrome and mild motor deficit as a sign of peripartal hypoxia. Although it probably belongs to normal reflexes, intermittent FGUC should be US controlled. Persistent FGUC should be considered pathological for its possible hypoxic effect and umbilical circulation obstruction. These pregnant women should be hospitalized and closely monitored, as in part confirmed by the present study.
D000328:Adult; D001157:Arterial Occlusive Diseases / Q000209:etiology; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005311:Fetal Hypoxia / Q000000981:diagnostic imaging / Q000209:etiology*; D005324:Fetal Movement; D005865:Gestational Age; D006225:Hand / Q000196:embryology*; D018737:Hand Strength; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015931:Intensive Care, Neonatal; D008470:Meconium; D021041:Placental Circulation; D011247:Pregnancy; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries; D014470:Umbilical Cord; D014655:Vascular Resistance