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1. A Framework for Scaling for Equity

Author

Carnegie Foundation for the Advancement of Teaching, Cohen-Vogel, Lora, Century, Jeanne, and Sherer, David

Abstract

For more than four decades, researchers, policymakers, professional educators, and the philanthropic community in education have wrestled with how to scale up promising pockets of reform. Centering equity in scaling efforts means working with and prioritizing students who have historically lacked access to powerful learning opportunities, including deeper learning, and have not reached the ambitious outcomes we desire for everyone. This report seeks to help school district leaders and improvement teams define what it means to scale for equity. Presented in this report is a scaling-for-equity framework informed by the experiences of 10 research-practice partnerships (RPPs) and designed to provide readers with multiple, iterative opportunities to think about equity as it relates to scale. The scaling-for-equity framework supports a journey in which members of a team work to improve educational practice by traveling over time from their origin to a destination. The framework and accompanying tools are designed to: (1) help improvement teams navigate their scaling-for-equity journey; and (2) support school district leaders striving to transform their communities' public education systems into equitable ones by prompting improvement team members to consider equity-related questions during all stages of the work and to develop shared responses, describing and categorizing scaling strategies so that teams can identify the strategies, alone or in combination, that will bring them closer to their equity goals, and providing support for disentangling and addressing the many influences and tensions at play when improvement teams aim to bring about change.

Published
2022

2. The Social Structure of Networked Improvement Communities: Cultivating the Emergence of a Scientific-Professional Learning Community

Author

Carnegie Foundation for the Advancement of Teaching, Russell, Jennifer Lin, Bryk, Anthony S., Peurach, Donald J., Sherer, David, LeMahieu, Paul G., Khachatryan, Edit, Sherer, Jennifer Z., and Hannan, Maggie

Abstract

A burgeoning set of education-related organizations join networks each year, reflecting a shared belief that problems in education are too complex for any one educator or organization to solve on their own and that collaboration can support educational improvement. The goal of this paper is to describe how networked improvement communities (NICs) create a social structure to catalyze the type of community that can solve complex problems. We draw from prior theorizing, the research literature on network and learning community development, and observations of developing NICs to articulate a framework for network development. The framework is intended to be an analytic tool for thinking and reasoning about NIC emergence and maturation. [This report was presented at the American Educational Research Association Annual Meeting, Toronto, ON.]

Published
2021

3. Evidence for Improvement: An Integrated Analytic Approach for Supporting Networks in Education

Author

Carnegie Foundation for the Advancement of Teaching, Sherer, David, Norman, Jon, Bryk, Anthony S., Peurach, Donald J., Vasudeva, Ash, and McMahon, Kelly

Abstract

Across the social sectors, a growing number of organizations are embracing continuous improvement approaches and organizing themselves as networks in order to attack complex problems. To succeed, networks must learn quickly by studying their own practices, continuously adapting to changing circumstances within their organizations and in the broader environment, and incorporating this learning into their ongoing work. In this paper, we describe an integrated approach--which we call Evidence for Improvement (EFI)--that explains how a variety of tools and practices drawn from diverse forms of program evaluation can inform the leaders of these networks in advancing productive change. We propose that improvement networks can be conceptualized and measured using a three-level nested model composed of a working theory of improvement, an improvement enterprise, and environmental contexts. As they engage in inquiry targeted at each level, those with evaluative expertise should become authentic partners with improvement leaders and fully align their analytic efforts with the improvement activities and social contexts of the network. The EFI approach we describe is designed to enhance a network's internal learning processes and, in turn, lead to more positive impacts for educators and students. It has implications for improvement practitioners, evaluators, and funders.

Published
2020

5. How School and District Leaders Access, Perceive, and Use Research

Author

Penuel, William R., Briggs, Derek C., Davidson, Kristen L., Herlihy, Corinne, Sherer, David, Hill, Heather C., Farrell, Caitlin, and Allen, Anna-Ruth

Abstract

This study examined how school and district leaders access, value, and use research. From a representative sample of school districts across the United States, we surveyed 733 school and district leaders as part of an effort to develop understanding of the prevalence of research use, the nature of leaders' attitudes toward research, and individual and organizational correlates of research use. School and district leaders alike reported frequent use of research use and generally positive attitudes toward research. Leaders reported accessing research primarily through their professional networks. Those in certain roles, those pursuing or holding an advanced degree, and those who reported a strong organizational culture of evidence use reported higher levels of research use. These findings suggest that policy efforts to promote evidence use among education leaders will be welcomed but that policy makers need to take into account the prevalence of various types of research use in designing supports for evidence use.

Published
2017

8. Getting Better at Getting Better: Improvement Dispositions in Education

Author

Biag, Manuelito and Sherer, David

Abstract

Background/Context: Continuous improvement methods are becoming increasingly popular in education. Existing research has emphasized the technical aspects of improvement practice and has rarely focused on important social phenomena that underlie improvement work, such as the mindsets and identities of successful practitioners. To address this gap, we conducted an exploratory study of educators involved with networked improvement communities (NICs). Purpose/Objective/Research Question/Focus of Study: Two questions guide our study: (1) How do participants in networked improvement communities describe the key dispositions of educational "improvers"? and (2) What do participants report as the types of activities, social processes, and tools that enable the development of these dispositions? Research Design: We used purposive and snowball sampling to recruit participants from diverse roles and who had received training in improvement science and/or had been involved in a NIC. We asked respondents to refer us to colleagues who were incorporating improvement science principles and tools into their professional work. In total, we interviewed 22 participants. Data Collection and Analysis: We conducted semistructured, virtual interviews using Zoom. We audio-recorded and transcribed verbatim each interview for analysis. Through a collaborative and progressive process using NVivo 12 software, we applied open and axial coding methods to the data to identify emergent themes and patterns. Findings/Results: Respondents report that educational improvers engage in disciplined inquiry, adopt a learning stance, take a systems perspective, possess an orientation toward action, seek the perspective of others, and persist beyond initial improvement attempts. Results also suggest that having opportunities to practice improvement with guidance from a coach, having access to a learning community of trusted colleagues, working in an environment where there are resources to support improvement work, and having leaders who model an improvement mindset support educators' ability to engage in new practices that shift how they see themselves and relate to their work. Conclusions/Recommendations: This study helps identify important dispositions associated with continuous improvement work in education. It also highlights the potential for NICs to bring about substantive changes in how participants connect to their professional practice, as well as with their colleagues, and how they pursue solutions to complex problems. Our research also suggests the need to provide educators with authentic opportunities to engage in fundamentally novel types of activities to cultivate new ways of approaching work that help all students learn and succeed.

Published
2021

9. Findings from a National Study on Research Use among School and District Leaders. Technical Report No. 1

Author

National Center for Research in Policy and Practice (NCRPP), University of Colorado Boulder (UCB), School of Education, Northwestern University, School of Education and Social Policy, Harvard University, Center for Education Policy Research (CEPR), Penuel, William R., Briggs, Derek C., Davidson, Kristen L., Herlihy, Corinne, Sherer, David, Hill, Heather C., Farrell, Caitlin C., and Allen, Anna-Ruth

Abstract

Since its establishment in 2002, the Institute of Education Sciences (IES) at the U.S. Department of Education has funded dozens of field-initiated efficacy and scale-up studies of interventions, released multiple evaluation studies of major policy initiatives, supported rigorous studies of programs through the Regional Educational Laboratories, and funded training grants to prepare new scholars to conduct high quality research in education. Still there is limited understanding of how educational leaders access and use research. Developing knowledge about when leaders seek out research, where leaders find it, and the purposes for which they use it is critical if education research is to inform policy and practice. To date, a key obstacle to studying research use at scale has been the absence of valid survey measures. Though a number of studies have examined uses of research through interview, observation, and case study methods, survey measures adequate for drawing inferences about how leaders use research have not been developed. This report presents results of the efforts of the National Center for Research in Policy and Practice (NCRPP) to address this need. The NCRPP is an IES-funded center focused on the study of knowledge utilization among school and district leaders in the United States. To develop an understanding of how school and district leaders use research, a survey of research use was developed and administered to a nationally representative sample of school and district leaders. The following questions were asked: (1) How frequently do school and district leaders use research and for what purposes; (2) What research do school and district leaders find useful; (3) What are leaders' attitudes toward research; and (4) Where do leaders access research? This report describes the instrument development process, the generation of the sample, the reliability of survey scales used and the ability of scales to discriminate among respondents with different types of attitudes, and the frequency distributions for responses to most items. Key conclusions and next steps are discussed.

Published
2016

13. The Status of the Teaching Profession 2011

Author

Center for the Future of Teaching and Learning at WestEd, California State University, Public Policy Institute of California, University of California, Office of the President, SRI International, Bland, Jennifer, Sherer, David, Guha, Roneeta, Woodworth, Katrina, Shields, Patrick, Tiffany-Morales, Juliet, and Campbell, Ashley

Abstract

This paper presents the Center for the Future of Teaching and Learning at WestEd's 13th annual report on the status of the teaching profession in California, focusing on the role of the principal in supporting teaching quality. More specifically, the report discusses fiscal and policy trends, the competing demands of the principalship, implications of budget cuts for principals and teachers, and the state's teacher evaluation system. The report draws on numerous data sources, including a statewide survey of public school principals; interviews with principals, teachers, district officials, and state-level education leaders; and analyses of secondary data, including the limited data available on the composition of the state's teacher workforce. The Center for the Future of Teaching and Learning at WestEd believes that in this challenging high-stakes environment, ensuring teacher effectiveness is fundamental to helping students reach today's high academic standards. The report offers recommendations to address the following four areas identified as essential to support teachers, principals, and policymakers in improving education outcomes for all students, particularly as the state and local districts prepare for delivery of the Common Core Standards: (1) Reinvent evaluation and support for teachers to focus on student learning, with the goal of improving both teaching and learning; (2) Reinvent evaluation and support for principals to focus on improved teaching and learning, as well as improvement of their own practice; (3) Support both principals and teachers in transitioning to the newly adopted Common Core Standards; and (4) Ensure that California has a trustworthy and easily accessible data system for teacher and principal information. Appended are: (1) Research Methods; (2) Additional Graphs and Source & Technical Information for Secondary Data; and (3) Source & Technical Information for Survey Data. A glossary is included. (Contains 65 exhibits and 45 footnotes.) [For "The Status of the Teaching Profession 2011. Summary Report," see ED527744.]

Published
2011

14. Institutional Complexity and Policy Implementation: How Underlying Logics Drive Teacher Interpretations of Reform

Author

Bridwell-Mitchell, E. N. and Sherer, David G.

Abstract

One critical factor in policy implementation is how teachers interpret policy. Previous research largely overlooks how the broader culture shapes teachers' interpretations. In the current research, we explore how teachers' interpretations of instructional reforms are associated with the logics of broad societal institutions. Our longitudinal mixed-methods study of 117 teachers at three urban public schools demonstrates that teachers' interpretations are rooted in market accountability logics, professional bureaucracy logics, and communal sentiment logics. Teachers' logics partially depend on their school and community contexts. The most substantive differences in teachers' logics result from individual attributes, namely, race/ethnicity. One implication is that effective policy implementation depends on formulation and framing that address the multiple and potentially competing logics that motivate teachers' responses to reform.

Published
2017
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22. Current Perspectives of Prenatal Cell-free DNA Screening in Clinical Management of First-Trimester Septated Cystic Hygroma

Author

Sherer,David M, Hsieh,Vicky, Hall,Anika, Gerren,Allison, Walters,Erin, Dalloul,Mudar, Sherer,David M, Hsieh,Vicky, Hall,Anika, Gerren,Allison, Walters,Erin, and Dalloul,Mudar

Abstract

David M Sherer, Vicky Hsieh, Anika Hall, Allison Gerren, Erin Walters, Mudar Dalloul The Division of Maternal Fetal Medicine, the Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, New York, USACorrespondence: David M Sherer, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, Box 24, Brooklyn, NY, 11203, USA, Tel +001-718-270-2081, Fax +001-718-270-4122, Email davidmsherer@gmail.comAbstract: First-trimester septated cystic hygroma occurs in approximately 1 in 268 pregnancies and has long been associated with a markedly increased risk of fetal aneuploidy and, among euploid fetuses, an increased risk of structural anomalies primarily affecting the cardiac and skeletal systems. Invasive prenatal diagnosis – chorionic villus sampling and/or amniocentesis – encompasses the time-honored clinical tools for the next step in management following prenatal sonographic diagnosis of first-trimester septated cystic hygroma. Currently, prenatal cell-free DNA (cfDNA) screening for fetal aneuploidy with select microdeletions is gradually replacing the considerably less sensitive, and labor-intensive combined first-trimester screening. These new technologies have opened potential new venues in the clinical management of this ominous late first-trimester sonographic diagnosis. Advances in cfDNA technologies are now permitting detection of chromosomal copy number variants (CNV) larger than 7Mb across genome and select serious single-gene disorders (mainly impacting skeletal and neurological development), affecting quality of life and may benefit from medical and/or surgical management. This commentary will address the available non-invasive prenatal screening technologies, which clearly enhance immediate genetic analysis modalities applicable in the presence of the complex sonographic fi

Published
2022

27. Scaling up STEM Academies Statewide: Implementation, Network Supports, and Early Outcomes

Author

Young, Viki, House, Ann, Sherer, David, Singleton, Corinne, Wang, Haiwen, and Klopfenstein, Kristin

Abstract

This chapter presents a case study of scaling up the T-STEM initiative in Texas. Data come from the four-year longitudinal evaluation of the Texas High School Project (THSP). The evaluation studied the implementation and impact of T-STEM and the other THSP reforms using a mixed-methods design, including qualitative case studies; principal, teacher, and student surveys; and a quasi-experimental approach to examining the effects of the programs on student achievement and achievement-related behaviors. The chapter presents a brief description of T-STEM characteristics and early outcomes on math and science achievement. It then examines variation in the local interpretation and enactment of the blueprint designed to guide T-STEM academy development. A multidimensional infrastructure supported T-STEM implementation and provided needed technical assistance. Yet T-STEM academies' primary affiliations through their district or external support network provided the strongest context for implementation, shaping priorities and affording resources and know-how. The chapter offers key lessons for policymakers and practitioners engaged in supporting STEM efforts in particular and new school models in general.

Published
2016

30. Common Raven Impacts on Nesting Western Snowy Plovers: Integrating Management to Facilitate Species Recovery

Author

Strong, Cheryl, Neuman, Kriss K., Hutchinson, Jenny L., Miller, Jamie K., Clark, Amber L., Chang, Lena, Iwanicha, Joanna, Feucht, Elizabeth, Lau, Matthew J., Lauten, David J., Markegard, Sarah, Pearl, Benjamin, Sherer, David L., Tertes, Rachel, Tharratt, Susie, and Wooten, Travis

Subjects
common raven, threatened species, western snowy plover, coordinated management, Corvus corax, nesting success, Ecology and Evolutionary Biology, Natural Resources Management and Policy, predator management, species recovery, Pacific coast, Biology, Charadrius nivosus nivosus
Abstract

The U.S. Pacific coast population of the western snowy plover (Charadrius nivosus nivosus; plover) has declined due to loss and degradation of coastal habitats, predation, and anthropogenic disturbance. The U.S. Fish and Wildlife Service listed the subspecies in 1993 as threatened under the Endangered Species Act due to the population declines and habitat loss. Predation of nests and chicks has been identified as an important cause of historic population declines, and thus, most predator management actions for this subspecies are focused on reducing this pressure. In recent years, common ravens (Corvus corax; ravens) have become the most common and pervasive predators of plover nests and chicks, especially in areas with subsidized food sources for ravens and sites without predator management. We compiled data from a variety of sources to document the impact of raven predation on plover nesting success. We discuss current raven management and suggest several tools and strategies to increase plover nesting success, including multi-state approval for the use of the avicide DRC-1339, the use of lures and new trap types, and an increase in funding for predator management. The lack of coordinated and integrated management continues to impede the recovery of the Pacific coast plover population.

Published
2021
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31. Current Perspectives of Prenatal Sonography of Umbilical Cord Morphology

Author

Sherer,David M, Al-Haddad,Sara, Cheng,Regina, Dalloul,Mudar, Sherer,David M, Al-Haddad,Sara, Cheng,Regina, and Dalloul,Mudar

Abstract

David M Sherer, Sara Al-Haddad, Regina Cheng, Mudar Dalloul The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USACorrespondence: David M ShererDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, Box 24, Brooklyn, NY, USATel +1 718 270-2081Fax +1 718 270-4122Email davidmsherer@gmail.comAbstract: The umbilical cord constitutes a continuation of the fetal cardiovascular system anatomically bridging between the placenta and the fetus. This structure, critical in human development, enables mobility of the developing fetus within the gestational sac in contrast to the placenta, which is anchored to the uterine wall. The umbilical cord is protected by unique, robust anatomical features, which include: length of the umbilical cord, Wharton’s jelly, two umbilical arteries, coiling, and suspension in amniotic fluid. These features all contribute to protect and buffer this essential structure from potential detrimental twisting, shearing, torsion, and compression forces throughout gestation, and specifically during labor and delivery. The arterial components of the umbilical cord are further protected by the presence of Hyrtl’s anastomosis between the two respective umbilical arteries. Abnormalities of the umbilical cord are uncommon yet include excessively long or short cords, hyper or hypocoiling, cysts, single umbilical artery, supernumerary vessels, rarely an absent umbilical cord, stricture, furcate and velamentous insertions (including vasa previa), umbilical vein and arterial thrombosis, umbilical artery aneurysm, hematomas, and tumors (including hemangioma angiomyxoma and teratoma). This commentary will address current perspectives of prenatal sonography of the umbilical cord, including structural anomalies and the potenti

Published
2021

32. Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of Complex Umbilical Cord Entanglement

Author

Sherer,David M, Roach,Crystal, Soyemi,Sarin, Dalloul,Mudar, Sherer,David M, Roach,Crystal, Soyemi,Sarin, and Dalloul,Mudar

Abstract

David M Sherer, Crystal Roach, Sarin Soyemi, Mudar Dalloul The Division of Maternal-Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USACorrespondence: David M ShererDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, Box 24, Brooklyn, NY, 11203, USATel +1 718 270-2081Fax +1 718 270-4122Email davidmsherer@gmail.comAbstract: Diagnosis of potential umbilical cord compromise, namely, true knots of the umbilical cord and nuchal cords has been enabled with increasing accuracy with current enhanced prenatal sonography. Often an incidental finding at delivery, the incidence of true knots of the umbilical cord has been estimated at between 0.04% and 3% of deliveries. This condition has been reported to account for a 4 to 10-fold increase of stillbirth and perinatal morbidity of 11% of cases. Nuchal cords, commonly observed at the delivery of uncompromised, non-hypoxic non-acidotic newborns occur more frequently with single nuchal cords noted in between 20% and 35% of all deliveries at term. Multiple nuchal cords are considerably less frequent, with decreasing frequencies inverse to the number of nuchal cord loops. While clearly single (and likely double) nuchal cords are almost uniformly associated with favorable neonatal outcomes, emerging data suggest that cases of ≥ 3 loops of nuchal cords are more likely to be associated with an increased risk of adverse perinatal outcome (either stillbirth or compromised neonatal condition at delivery). We define cases of a true knot of the umbilical cord, cases of ≥ 3 loops of nuchal cords, any combination of a true knot and nuchal cord, or any umbilical cord entanglement (nuchal or true knot) in the presence of a single umbilical artery, in singleton gestations as complex umbilical cord entanglement.

Published
2021

35. Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of Nuchal Cord(s)

Author

Sherer, David M, Ward, Kayana, Bennett, Michelle, and Dalloul, Mudar

Subjects
prenatal ultrasound, Commentary, International Journal of Women's Health, nuchal cord
Abstract

David M Sherer, Kayana Ward, Michelle Bennett, Mudar Dalloul Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USACorrespondence: David M ShererDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, Box 24, Brooklyn, NY, USATel +1 718 270-2081Fax +1 718 270-4122Email davidmsherer@gmail.comAbstract: Umbilical cord accidents preceding labor are uncommon. In contrast, nuchal cords are a very common finding at delivery, with reported incidences of a single nuchal cord of approximately between 20% and 35% of all singleton deliveries at term. Multiple loops occur less frequently, with reported incidence rates inverse to the number of nuchal cords involved. Rare cases of up to 10 loops of nuchal cord have been reported. While true knots of the umbilical cord have been associated with a 4– 10-fold increased risk of stillbirth, nuchal cord(s) are most often noted at delivery of non-hypoxic non-acidotic newborns, without any evidence of subsequent adverse neonatal outcome. Prior to ultrasound, nuchal cords were suspected clinically following subtle (spontaneous or evoked) electronic fetal heart rate changes. Prenatal sonographic diagnosis, initially limited to real-time gray-scale ultrasound, currently entails additional sonographic modalities, including color Doppler, power Doppler, and three-dimensional sonography, which have enabled increasingly more accurate prenatal sonographic diagnoses of nuchal cord(s). In contrast to true knots of the umbilical cord (which are often missed at sonography, reflecting the inability to visualize the entire umbilical cord, and hence are often incidental findings at delivery), nuchal cord(s), reflecting their well-defined and sonographically accessible anatomical location (the fetal neck), lend themselves with relative ease to prenatal sonographic diagnosis, with increasingly high sensitivity and specificity rates. While current literature supports that single (and possibly double) nuchal cords are not associated with increased adverse perinatal outcome, emerging literature suggests that cases of ≥ 3loops of nuchal cords or in the presence of a coexisting true knot of the umbilicus may be associated with an increased risk of stillbirth or compromised neonatal status at delivery. This commentary will address current perspectives of prenatal sonographic diagnosis and clinical management challenges associated with nuchal cord(s) in singleton pregnancies.Keywords: prenatal ultrasound, nuchal cord

Published
2020

36. Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of True Knot of the Umbilical Cord

Author

Sherer,David M, Amoabeng,Opokua, Dryer,Alexandra M, and Dalloul,Mudar

Subjects
International Journal of Women's Health
Abstract

David M Sherer, Opokua Amoabeng, Alexandra M Dryer, Mudar Dalloul Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USACorrespondence: David M ShererDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, Box 24, Brooklyn, NY, USATel +1 718 270-2081Fax +1 718 270-4122Email davidmsherer@gmail.comAbstract: Umbilical cord accidents preceding labor are rare. Single and multiple nuchal cords, and true knot(s) of the umbilical cord, are often incidental findings noted at delivery of non-hypoxic non-acidotic newborns without any evidence of subsequent adverse neonatal outcome. In contrast to single nuchal cords, true knots of the umbilical cord, which occur in between 0.04% and 3% of all deliveries, have been associated with a reported 4 to 10 fold increased risk of stillbirth. First reported with real-time ultrasound, current widespread application of color Doppler, power Doppler and three-dimension sonography, has enabled increasingly more accurate prenatal sonographic diagnoses of true knot(s) of the umbilical cord. Reflecting the inability to visualize the entire umbilical cord at prenatal ultrasound assessment, despite detailed second and third-trimester scanning, many occurrences of incidental true knot of the umbilical cord remain undetected and are noted only at delivery. Although prenatal sonographic diagnostic accuracy is increasing, false positive sonographic diagnosis of true knot of the umbilical cord cannot be ruled out with certainty, and must continue to be considered clinically. Notwithstanding the inability to diagnose all true knots, currently there is a clear absence of clinical management guidelines by governing bodies regarding patients in whom prenatal sonographic diagnosis of true knot(s) of the umbilical cord is / are suspected. As a result, in many prenatal ultrasound units, suspected sonographic findings suggestive of or consistent with true knot of the umbilical cord are often disregarded, not documented, and patients are not uniformly informed of this potentially life-threatening condition, which carries an associated considerable risk of stillbirth. This commentary will address current perspectives of prenatal sonographic diagnostic and management challenges associated with true knot(s) of the umbilical cord in singleton pregnancies.Keywords: prenatal ultrasound, true knot of the umbilical cord

Published
2020

37. Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of Nuchal Cord(s)

Author

Sherer,David M, Ward,Kayana, Bennett,Michelle, Dalloul,Mudar, Sherer,David M, Ward,Kayana, Bennett,Michelle, and Dalloul,Mudar

Abstract

David M Sherer, Kayana Ward, Michelle Bennett, Mudar Dalloul Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USACorrespondence: David M ShererDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, Box 24, Brooklyn, NY, USATel +1 718 270-2081Fax +1 718 270-4122Email davidmsherer@gmail.comAbstract: Umbilical cord accidents preceding labor are uncommon. In contrast, nuchal cords are a very common finding at delivery, with reported incidences of a single nuchal cord of approximately between 20% and 35% of all singleton deliveries at term. Multiple loops occur less frequently, with reported incidence rates inverse to the number of nuchal cords involved. Rare cases of up to 10 loops of nuchal cord have been reported. While true knots of the umbilical cord have been associated with a 4– 10-fold increased risk of stillbirth, nuchal cord(s) are most often noted at delivery of non-hypoxic non-acidotic newborns, without any evidence of subsequent adverse neonatal outcome. Prior to ultrasound, nuchal cords were suspected clinically following subtle (spontaneous or evoked) electronic fetal heart rate changes. Prenatal sonographic diagnosis, initially limited to real-time gray-scale ultrasound, currently entails additional sonographic modalities, including color Doppler, power Doppler, and three-dimensional sonography, which have enabled increasingly more accurate prenatal sonographic diagnoses of nuchal cord(s). In contrast to true knots of the umbilical cord (which are often missed at sonography, reflecting the inability to visualize the entire umbilical cord, and hence are often incidental findings at delivery), nuchal cord(s), reflecting their well-defined and sonographically accessible anatomical location (the fetal neck)

Published
2020

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