title: Recurrent antepartum compression of a single artery double nuchal cord necessitating emergency cesarean delivery.
abstract: Fetuses with a single umbilical artery are considered at increased risk for chromosomal and structural abnormalities, and increased adverse perinatal outcome. A young nulliparous patient was followed with weekly nonstress testing due to well-controlled gestational diabetes, a single umbilical artery, and a double nuchal cord. At 31 weeks gestation, following the occurrence of a severe prolonged variable deceleration of the fetal heart rate the patient was hospitalized for close fetal surveillance with consideration that the deceleration may represent recurring intermittent compression of the single umbilical artery. Continuous fetal monitoring depicted recurrent severe variable decelerations of the fetal heart rate. Thirty-six hours after admission, prolonged fetal bradycardia to 60 bpm necessitated emergency cesarean delivery of a nonhypoxic nonacidotic fetus, which subsequently did well. This case suggests that fetuses with a single umbilical artery nuchal cord(s) may be at increased risk of significant umbilical cord compression.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn, New York 11203-2098, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Sherer
authors.forename: Fady
authors.initials: F
authors.lastname: Khoury-Collado
authors.forename: Mudar
authors.initials: M
authors.lastname: Dalloul
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Osho
authors.forename: Madelene D
authors.initials: MD
authors.lastname: Lamarque
authors.forename: Larissa
authors.initials: L
authors.lastname: Fomitcheva
authors.forename: Ovadia
authors.initials: O
authors.lastname: Abulafia
mesh_terms: D000328:Adult; D001034:Apgar Score; D002585:Cesarean Section; D004630:Emergencies; D005260:Female; D047109:Fetal Development / Q000502:physiology; D005323:Fetal Monitoring / Q000379:methods; D005324:Fetal Movement; D005500:Follow-Up Studies; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D048208:Nuchal Translucency Measurement; D010298:Parity; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D018566:Pregnancy, High-Risk; D011295:Prenatal Care / Q000379:methods; D012008:Recurrence; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000002:abnormalities* / Q000000981:diagnostic imaging