Fetal gasping of the umbilical cord and perinatal outcome

The grasp reflex (GR) is one of the "primitive" reflexes characteristic of intrauterine development and early infancy. The GR is evident by 16 weeks gestation and is usually well developed by 27 weeks. Normally, the GR is no longer found in healthy term infants 3 months after birth. A GR persisting after this time is taken as a sign of a frontal lobe lesion. Fetal grasping of the umbilical cord (FGUC), noted on ultrasonography late in pregnancy, is a possible cause of fetal hypoxia secondary to occlusion of the umbilical circulation. In this retrospective study, a total of 2439 ultrasound studies were carried out in 800 pregnancies over a 2-year period. FGUC was found in 7 normal singleton pregnancies at 32 to 41 weeks gestation. It was first noted at a median gestational age of 36 weeks; the median age at delivery was 39 weeks. All measurements of the umbilical artery resistance index (URI) were increased as a result of persistent FGUC. There were marked oscillations in values of resistance in the middle cerebral artery. In 2 cases, the cerebral/ umbilical was less than 1, indicating vasocentralization that presumably compensated for hypoxia. Pathologic cardiotocograms and preacidosis were observed in these cases. Two infants with pathologic cardiotocograms had the cord wound around the neck. All infants were discharged healthy from the neonatal intensive-care unit except for these 2, who had dystonia and mild motor deficit reflecting petipartum hypoxia. Intermittent FGUC probably is normal, but it calls for ultrasonographic monitoring. If persistent, FGUC is not normal and could obstruct the umbilical circulation and produce hypoxia. Women with persistent PGUC should be closely monitored in the hospital.