The Benefit of Active Management in True Knot of the Umbilical Cord: A retrospective study.
Author:
Weissbach Tal1ORCID, Lev Shir, Back Yonatan, Massarwa Abeer, Meyer Raanan, Miller Tal Elkan, Weissmann-Brenner Alina, Weisz Boaz, Mazaki-Tovi Shali, Kassif Eran
Affiliation:
1. Sheba Medical Center: Sheba Medical Center at Tel Hashomer
Abstract
Abstract
Purpose: To compare perinatal outcomes between active and routine management in true knot of the umbilical cord (TKUC).
Methods: A retrospective study of singletons born beyond 22 6/7 weeks with TKUC. Active management included weekly fetal heart rate monitoring(FHRM)≥ 30 weeks and labor induction at 36-37 weeks. Outcomes in active and routine management were compared, including composite asphyxia-related adverse outcome, fetal death, labor induction, Cesarean section (CS) or Instrumental delivery due to non-reassuring fetal heart rate (NRFHR), Apgar5 score <7, cord Ph <7, neonatal intensive care unit (NICU) admission and more.
Results: The Active (n=59) and Routine (n=1091) Management groups demonstrated similar rates of composite asphyxia-related adverse outcome (16.9% vs 16.8%, p= 0.97). Active Management resulted in higher rates of labor induction<37 weeks (22% vs 1.7%, p<0.001), CS (37.3% vs 19.2%, p=0.003) and NICU admissions (13.6% vs 3%, p<0.001). Fetal death occurred exclusively in the Routine Management group (1.8% vs 0%, p=0.6).
Conclusion: Compared with routine management, weekly FHRM and labor induction between 36-37 weeks in TKUC do not appear to reduce neonatal asphyxia. In its current form, active management is associated with higher rates of CS, induced prematurity and NICU admissions. Labor induction before 37 weeks should be avoided.
Publisher
Research Square Platform LLC
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