D R U G O R D E R E D B R A N D N

Is the Cord Around the Baby's Neck Really Dangerous?

As a confirmed birth junkie, I have heard over and over again birth stories where the baby was born by cesarean for either fetal distress or failure to descend, and the difficulties are blamed on "the cord was around the baby's neck". Is this condition - scientifically termed "nuchal cord" - actually dangerous? A new study backs up previous research showing that nuchal cord is not the threat it's perceived to be. A study published this year in the Journal of Perinatal Medicine showed there were no statistically significant differences in outcomes of post-term pregnancies involving a nuchal cord verses no nuchal cord. Drs. Ghosh and Gudmundsson performed color ultrasound on 202 women with post-term pregnancies. Nuchal cords were detected in 69 of the women. There were no significant differences in Apgar scores, umbilical cord anomalies, cesarean section, perinatal death or admission of the baby to the NICU (neonatal intensive care unit). These findings confirm what has been found in most of the past research on nuchal cord outcomes. A 2006 study from the Archives of Obstetrics and Gynecology was on a much larger scale, looking at the outcomes of 166,318 deliveries during a 15 year study period, 24,392 of which had a documented nuchal cord at birth. The authors, Sheiner et. Al, conclude: "Nuchal cord is not associated with adverse perinatal outcome. Thus, labor induction in such cases is probably unnecessary." The interesting thing about the Sheiner study is that despite the equivalent outcomes among nuchal cord babies and those without the cord wrapped around the neck, there were higher rates of labor induction and non-reassuring fetal heart tones during labor among the nuchal cord cases. These two factors are most likely related. We know without a doubt that induction of labor can cause fetal distress. The fact that there were higher induction rates in the nuchal cord group could very well explain the higher rate of transient fetal distress. Induction is nearly always accompanied by AROM (artificial rupture of membranes), which can cause undue pressure on the cord, which can in turn result in blips in the hearttones. Regardless of the cause, the outcomes were still good. Finally, we look at yet another study which demonstrated that nuchal cord does not result in worse outcomes. In a 2005 study looking at the effects of nuchal cord on birthweight and immediate neonatal outcomes, Mastrobattista, et. Al examined the outcomes of 4426 babies, 775 of whom had a nuchal cord. They found that there were no significant differences between the two groups in birthweight, nonreassuring fetal hearttones, Apgar scores below 7, or operative vaginal deliveries. The cesarean rate was actually highest among the women whose babies did not have a nuchal cord. The most important thing to keep in mind is that unborn babies do not breathe through their mouth and neck - they receive oxygen through the umbilical cord. This is why it normally doesn't matter if the cord is

around the neck (unless the cord is being compressed too much, which is fairly rare). The baby cannot "choke to death" before she/he is born. What we can conclude from the overwhelming majority of data is that nuchal cord - or "cord around the neck" - is not pathological; that is to say, it's not an abnormality. It is a normal condition of the umbilical cord and typically causes no problems with the delivery, even though doctors frequently try to convince parents otherwise. References: J Perinat Med. 2008;36(2):142-4. Nuchal cord in post-term pregnancy - relationship to suspected intrapartum fetal distress indicating operative intervention. Ghosh GS, Gudmundsson S. Department of Obstetrics and Gynecology, Malm University Hospital, Malm, Sweden.

My Child Birth Story Of Shoulder Dystocia and Forceps

My child birth story is one of shoulder dystocia and forceps. As I was sliding down the birth canal, I hooked my shoulder behind my mother's pelvic bone. My shoulder and subsequently the rest of my body became stuck, a condition medically referred to as shoulder dystocia. In order to deliver me, my mother's doctor opted to use forceps to dislodge my body from my mother. My child birth story could be considered a traumatic childbirth. My mother, lying on her back, struggles to birth me. I stubbornly wedge myself in her pelvis. The heroic doctor rescues me and her by yanking me out by my head with a pair of forceps. I still have scars to prove my harrowing child birth story, one crescent scar on my right cheek and another on my head. I also must have been really pissed off about my traumatic childbirth from being ripped from my uterine home because I am flipping off the camera with the hand that is covering my cheek wound in my baby picture.

I always liked to think of my child birth story as a reflection of my personality. I can be quite stubborn at times, especially when it comes down to doing something that I absolutely do not want to do. Stubborn as an adult, stubborn as a baby, right? However, after reading the book Unassisted Childbirth by Laura Kaplan Shanley, I began to seriously wonder about the psychological consequences of my child birth story. Was my traumatic childbirth a result of my inherent stubbornness, or is my stubbornness a result of my traumatic childbirth. Shanley argues that the psychological effects of trauma during childbirth affect people throughout their lives. Would I be a less stubborn person had my mother been allowed to move from out of her hospital bed in an effort to get me unstuck more naturally? I am not sure how much I buy into Shanley's argument, but the notion does make me think.

If nothing else, my child birth story of a traumatic childbirth complete with shoulder dystocia and forceps helps me in my own considerations about the births of my children. I have already firmly decided that I will not be forced to lay flat on my back in a hospital room during childbirth. In fact, I most likely will not even be in a hospital room as the child birth story of my baby unfolds. I plan to give birth in the comfort of my own home, preferably on my hands and knees or squatting. (I have already started practicing squatting to help my body prepare for its own child birth story.) I will not be persuaded or coerced into any unnecessary interventions when the child birth that I want is normal, natural, and calm. Even though I am not sure that a traumatic childbirth affects a person as much as Shanley believes. Then again, my stubbornness is going to get me the child birth story that I want, so maybe there is something to birth affecting life.

Brand Name: Cortastat, Dalalone, Decadrol, Decaject, Deronil, Dexacorten, Dexameth, Dexasone, Dexone, Hexadrol, Primethasone, Solurex Classification: Long- acting corticosteroid Indications 1.Management of cerebral edema 2.Diagnostic agent in adrenal disorders 3.Relieves inflammation 4.Allergic disorders 5.Asthma 6.Arthritis Mechanism of Action Dexamethasone suppresses inflammation and the normal immune response. It prevents the release of substances in the body that causes inflammation. Contraindications 1.Hypersensitivity 2.Active untreated infection 3.Lactation 4.Systemic fungal infection Use Cautiously in: 1.Children (chronic use may result in decreased growth) 2.Stress (surgery or infections) 3.Potential infections as dexamethasone may mask the signs of infection such as fever and inflammation. 4.Pregnancy (safety is not established with the sue of the drug during pregnancy) Side Effects 1.Acne 2.Decreased wound healing 3.Depression 4.Vomiting 5.Easy bruising 6.Headache 7.Increased hair growth 8.Insomnia 9.Restlessness 10.Stomach irritation 11.Irregular or absent menstruation 12.Dizziness Adverse reactions If these signs and symptoms will be noted instruct the patient to call or notify the physician immediately. 1.Skin rash 2.Swollen face, legs or ankles (fluid retention) 3.Vision problems ( Dexamethasone may cause cataracts and increased intraocular pressure) 4.Cold or infection that last for a long time 5.Muscle weakness 6.Black or tarry stool (suggestive of peptic ulceration caused by Dexamethasone use) Route and Dosage Cerebral Edema PO (Adults): 2 mg q 8-12 hours IM, IV (adults): 10 mg initially IV, 4 mg q 6 hr, may be decreased to 2 mg q 8-12 hr, then change PO.

Adrenocortical Insufficiency/Anti-inflammatory PO (Adults): 0.5-9 mg daily in single or divided doses PO (children): 23.3 mcg/kg in 3 divided doses. IV (Adults): 0.5-24 gm/day IM (Adults): 8-16 mg q 1-3 wk Nursing Interventions 1.Monitor intake and output of patient. 2.Observe the patient for peripheral edema, steady weight gain, rales or crackles or dyspnea. Notify the physician immediately if these clinical manifestations are noted. 3.Periodic growth evaluation for children should be done time to time. 4.For patients with cerebral edema, assess then for level of consciousness changes and headache during the therapy. 5.Guaiac-test stools should be carried out. Guaiac-positive stools should be reported to the physician immediately. 6.Administer with meals to minimize GI irritation. 7.For patients with difficulty swallowing, tablets can be crushed and administered with fluids or food. However, capsules should be swallowed whole. 8.Educate the patient to take missed doses as soon as remembered, unless almost time for the next dose skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. 9.Instruct patient to avoid people with known infection and contagious illnesses ascorticosteroids causes immunosuppression and may mask symptoms of infection.