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NI FEATURE: FACING ADVERSITY…TOMORROW IS ANOTHER DAY! - LETTER TO EDITOR
Year : 2017  |  Volume : 65  |  Issue : 5  |  Page : 1130-1131

MRI findings in a fetus with a tight cord around the neck


1 Department of Radiology, Sri Ramachandra University, Chennai, Tamil Nadu, India
2 Department of Obstetrics and Gynaecology, Sri Ramachandra University, Chennai, Tamil Nadu, India

Date of Web Publication6-Sep-2017

Correspondence Address:
Haree S Meganathan
Department of Radiology, Sri Ramachandra University, Chennai - - 600 116, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/neuroindia.NI_671_16

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How to cite this article:
Meganathan HS, Rajeshwaran R, Bhuvana S. MRI findings in a fetus with a tight cord around the neck. Neurol India 2017;65:1130-1

How to cite this URL:
Meganathan HS, Rajeshwaran R, Bhuvana S. MRI findings in a fetus with a tight cord around the neck. Neurol India [serial online] 2017 [cited 2019 Dec 15];65:1130-1. Available from: http://www.neurologyindia.com/text.asp?2017/65/5/1130/214061


Sir,

We would like to report the cerebral magnetic resonance imaging (MRI) findings in a fetus with a tight cord around the neck. We could not find a similar article in our literature search. A primigravida of 38 weeks presented to the obstetric department with complaints of decreased fetal movements since morning. An emergency sonography was performed and a diagnosis of intrauterine fetal demise (IUD) was made. As the pregnancy so far had been uneventful with timely checkups and scans, the couple were curious about the cause of death and insisted on an MRI of the fetus. Fetal MRI done on the same day revealed that the umbilical cord was wrapped tightly around the neck twice [Figure 1]a, [Figure 1]b. Intracranial MRI findings were subarachnoid hemorrhage in the sulcal spaces, basal cisterns, and bilateral lateral ventricles [Figure 1]d, [Figure 1]e and [Figure 1]f. Additional MRI findings were bilateral mild pericardial and right pleural effusions [Figure 1]c. The fetus was delivered after induction of labor. Radiologically, the cause of death was attributed to fetal asphyxia due to the tight nuchal cord, which was confirmed on physical examination and autopsy. Physical examination of the fetus confirmed two loops of cord tightly wound around the neck [Figure 2]. There were multiple peticheal hemorrhages on the skin [Figure 2].
Figure 1: Coronal (a) and sagittal (b) T2-weighted images of the fetal neck show two loops of the umbilical cord tightly wrapped around the fetal neck (arrows).(c) Mild pericardial effusion and right-sided pleural effusion are also seen (arrow heads). Axial gradient images (d, e and f) of the fetal brain show subarachnoid hemorrhage in the lateral ventricle, sylvian cistern, and sulcal spaces

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Figure 2: Physical examination shows two loops of the umbilical cord tightly wrapped around the fetal neck (arrows). Multiple petechial hemorrhages are seen on the fetal skin (arrow heads)

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Nuchal cord is a condition where the umbilical cord wraps 360° around the neck of the fetus. Though the reported prevalence rate varies between 12% at 24–26 weeks to 37% at term, approximately half of the cases resolve spontaneously.[1] According to the Giacomello classification system, if the cord can spontaneously unwind, it is categorized as Type I, and if it cannot, it belongs to Type II (the latter condition termed as the ‘true knot of the nuchal cord').[2] True knots are predominantly seen in fetuses with longer cords, in male fetuses, and in multiparous women.[3] Intrapartum factors associated with nuchal cord are slow progression of labor, induction of labor, and shoulder dystocia.[3] Single cord around the neck generally does not show significant morbidity or mortality and can be managed like any other pregnancy.

Cases where there is a tight cord around the neck are termed “tCAN syndrome,” and they have pathognomonic neurological, cardiorespiratory, and physical features.[4] The tight constriction of the cord at the neck can cause fetal cerebral asphyxia; or, the constriction of umbilical venous followed by arterial blood flow can lead to cardiorespiratory features such as fetal heart rate deceleration, umbilical arterial metabolic acidemia, neonatal anemia, and decreased fetal movements.[4] In extreme cases, intrauterine death can occur. It has been reported that the autopsy findings are in congruence with that of a hanging victim with features such as vascular compression of internal organs, renal infarction, as well as thymic, pleural, and pericardial petechiae. Even if the fetus survives, postnatally, the baby can show complications such as autism, cerebral palsy, and persistent pulmonary hypertension of the newborn.[5] In the cases where intrauterine death occurs at term, the postmortem reports most of the time show a tight cord around the neck.[5] Although colour Doppler is the modality of choice to confirm the diagnosis of a nuchal cord, fetal MRI can be used as a complementary tool in the assessment of additional features of fetal asphyxia.

Thus, tight cord around the neck is an important cause of sudden fetal demise. The surviving fetuses can show sequelae due to hypoxic ischemic encephalopathy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

1.
Peregrine E, O'Brien P, Jauniaux E. Ultrasound detection of nuchal cord prior to labor induction and the risk of Cesarean section. Ultrasound Obstet Gynecol 2005;25:160-4.  Back to cited text no. 1
    
2.
Collins JH. Umbilical cord accidents: Human studies. Semin Perinatol 2002;26:79-82.  Back to cited text no. 2
[PUBMED]    
3.
Blickstein I, Shoham-Schwartz Z, Lancet M. Predisposing factors in the formation of true knots of the umbilical cord-analysis of morphometric and perinatal data. Int J Gynecol Obstet 1987;25:395-8.  Back to cited text no. 3
[PUBMED]    
4.
Peesay M. Cord around the neck syndrome. BMC Preg Childbirth 2012;12:1-2.  Back to cited text no. 4
    
5.
Collins JH, Collins CL. The human umbilical cord. In: Kingdom J, Jauniaux E, O'Brien S, editors. The Placenta: Basic Science and Clinical Practice. London, RCOG Press; 2000. p. 319-27.  Back to cited text no. 5
    


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