应用超声评估脐带旋转指数与脐带附着部位的关系

目的观察脐带较少螺旋状盘绕与脐带在胎盘附着部异常是否相关.方法超声检测303位中晚期妊娠的胎儿脐带盘绕情况,1与脐动脉螺旋行走一周脐静脉的长度(A)的比值,定义为脐带旋转指数,1/A小于0.1考虑为少旋转.分娩后测量脐带附着点到胎盘边缘的距离,将结果分为正常附着、边缘性附着和帆状附着.结果少旋转的胎儿脐带约68%为异常附着,仅有1.4%的旋转指数≥0.1(P＜0.05).结论脐带少旋转与脐带异常附着有高度相关性,如存在脐带少旋转则可提示存在脐带异常附着,并为产科处理提供有利帮助.     

新生儿脐带异常诊断与处理

脐带是连接于胎儿与胎盘之间索条状结构 ,长约 40～ 6 0cm,粗约 1.5～ 2 .0 cm。含一脐静脉 ,两脐动脉 ,血管周围为华通氏胶 ,通过脐血管将氧及营养物质送入胎儿体内 ,同时将胎儿产生的 CO2 及代谢物质自脐血管经胎盘渗出体外 ,由母体排出。在分娩期若脐血管受压 ,血流受阻或因其他因素使胎儿循环发生障碍 ,可致胎儿窘迫或围产儿死亡。1　分娩期常见的脐带异常1.1　脐带缠绕　脐带缠绕于胎儿颈部最为常见 ,绕颈 1周者占 2 0 % ,2周约 2 .5 %。脐带长度正常者一般绕颈 1～ 2周在孕期对胎儿影响不大 ,增加可致胎儿窘迫 ,尤其脐带过短者更为不…     

胎儿脐带帆状附着超声表现1例

孕妇 2 8岁 ,孕 4产 0 ,孕 2 8周。常规超声检查显示 :胎儿各项测值均在正常范围内 ,胎盘附着面呈“网格样”回声 ,分布不均匀 ,内可见血流信号 ,为静脉频谱 (图 1)。超声提示 :宫内活胎 ,胎盘回声改变 ,建议密切随访。该孕妇自本次检查后一直超声随访 ,胎儿生长发育均正常 ,孕 3 8 3 周时因阴道出血剖腹产下一女婴。手术所见 :婴儿产后评分正常 ,检查脐带呈“帆状”附着。病理检查 :(胎盘 )畸形脐带 ,“帆状”附着 ,假结。讨论　脐带正常附着在胎盘中心和偏心者约为 90 % ,球拍胎盘约占 10 % ,“帆状”附着仅占 1%左右。脐带“帆状”附着是…     

能量多普勒三维血管成像技术在胎盘脐带附着异常诊断中的应用价值

目的 探讨能量多普勒三维血管成像技术(3D-PDA)在脐带附着异常诊断中的应用价值.方法 对50例常规超声检查疑为脐带附着异常的胎儿行3D-PDA检查并随访,将3D-PDA结果与产后胎盘隋况进行比较.结果 3D-PDA诊断脐带附着异常46例,其中球拍状胎盘(脐带边缘附着)38例,3D-PDA显示脐带边缘附着,多角度可见血管树从附着点逐渐深入胎盘;帆状胎盘(脐带帆状附着)8例(3例合并有副胎盘),3D-PDA显示脐带帆状附着,多角度可见脐带根部附着于胎膜上,附着处未见胎盘组织.3D-PDA诊断结果与产后结果一致,诊断准确率100％.结论 3D-PDA能准确、直观地显示脐带附着点及其走行情况,在脐带附着异常的诊断中有重要价值.     

脐带打结致死胎的超声表现1例

孕妇，26岁。平素体健，孕1产0，妊娠36周，自觉胎动2d。常规超声检查：见胎儿双顶径8.7cm，颅内未见结构异常，脊柱完整，四肢结构未见异常，胎心搏动消失。胎盘附着于子宫前壁，成熟度为Ⅱ级。羊水指数17.4，羊水透声佳，在羊水液性暗区中见一长约8.6cm似“粗麻花”样异常脐带回声（图1），CDEI未见血流信号。超声诊断：1.胎死宫内；2.脐带异常-打结可能。部腹产下一死男婴，胎儿胎盘未见结构异常，脐带长约75cm，胎儿侧见一长约9cm脐带过度扭曲，吃呈结节状，颜色黯黑。     

超声诊断胎儿脐带囊肿1例

患者女,34岁,停经6个月余,来我院行产前常规超声检查。平素身体健康,月经规律,无流产病史,夫妻双方无家族遗传病史。超声所见:胎儿双顶径约70 mm,头围径约263 mm,颅骨呈圆形光环,脑中线居中,脊柱双光带平行排列,整齐连续。胎儿心脏:四腔心切面可显示,胎儿心率137次/min,心律齐,胎儿四肢显示清楚,股骨长约54 mm,腹围约238 mm,胎儿腹部内脏:肝、胃、双肾、膀胱可见,胎儿双侧肾盂无分离。羊水指数为155 mm,胎儿脐带:脐动脉2条,脐静脉1条,胎盘附着在子宫后壁,胎盘成熟度I级,厚约30 mm。脐带在近胎盘端可见一     

彩超诊断胎儿脐带异常附着的临床意义

目的：探讨超声诊断脐带附着异常的临床意义。方法：收集我院经彩超诊断或产后证实胎儿脐带异常附着105例,并探讨其临床意义。结果：105例胎儿脐带异常附着,其中包括92例球拍胎盘,13例帆状胎盘,合并血管前置4例。临床上合并宫内发育迟缓2例,产前出血15例,胎儿宫内死亡3例。结论：彩超是诊断脐带异常附着重要检查方法,产前诊断能降低胎儿死亡率。     

两阶段筛查脐带边缘附着预测帆状附着的可行性研究

目的：通过分析早孕期脐带边缘附着于子宫下1/3段的超声特征预测中孕期进展为帆状附着的可行性。资料与方法：选取2018年2月—2022年11月我院早孕期经超声诊断的脐带边缘附着于子宫下1/3段的102例孕妇为研究对象,按照脐带附着位置（CI）距胎盘边缘距离分为2组：≤5 mm(A组29例)、>5 mm(B组73例),采取早、中孕两阶段序贯筛查CI的变化,找出脐带边缘附着进展为帆状附着的超声特征并分析其原因。结果：102例孕妇中,A组29例,B组73例,中孕期A组中7例进展为帆状附着,发生率为24.13%,B组未发现进展为帆状附着的病例,出生后经临床检查证实进展为帆状附着8例,漏诊1例;通过观察比较,脐带边缘附着进展为帆状附着的超声特征：早孕期脐带附着于子宫下1/3段,CI距胎盘边缘≤5 mm,中孕期胎盘附着于子宫前壁,胎盘位置正常,脐带附着处胎盘变薄或萎缩,差异有统计学意义（P<0.05）。结论：早孕期附着于子宫下1/3段的脐带边缘附着有进展为帆状附着的可能,应采取早、中孕两阶段序贯化筛查CI变化,提高帆状附着的产前诊断率,避免漏诊帆状化的脐带边缘附着。     

分娩时的脐带异常及处理

脐带是连接于胎儿胎盘之间索条状结构，长均40-60cm．粗约1．5—2．0cm。含一脐静脉、两条脐动脉，血管周围为华通纸胶．通过脐血管将氧气及营养物质送入胎儿体内．同时又将胎儿产生的CO2及代谢物质自脐血管经胎盘渗出体外由母体排出。在分娩期若脐血管受压，血流受阻，或因其他因素使胎儿循环发生障碍，可致胎儿窘迫或围产死亡。     

脐带异常对母婴的影响——附150例临床分析

脐带是胎儿吸收氧气和营养物质及排泄COZ等废物的重要通道，胎儿通过脐带和胎盘与母体相连接，进行营养和物质交换，若脐带发生组织结构的改变或机械性压迫，则可造成胎儿胎盘供血障碍，导致胎儿宫内窘迫，甚至死亡。脐带异常包括脐带缠绕、过长、过短、打结、脱垂和帆状附着，严重影响脐带功能。现就我院1996年1月～1997年3月住院孕产妇中诊断脐带异常150例进行回顾分析．重点报道其对胎儿的影响。116床资料1．回一般资料：1996年1月～1997年3月分娩产妇1876例，发现脐带异常150例，发生率为8％。年龄20～41岁，平均年龄为28．4士4．3岁…     

Sonographic evaluation of umbilical cord insertion with umbilical coiling index.

PURPOSE: The aim of this study was to investigate the association between umbilical cord hypocoiling and abnormal placental insertion of the umbilical cord. METHODS: Umbilical coiling was measured by sonography in 253 pregnant women in their second or third trimester. An umbilical coiling index, defined here as the reciprocal of the length of 1 umbilical vascular coil, of less than 0.1 was considered hypocoiled. The distance from the placental edge to the insertion of the umbilical cord was measured after delivery, and the results were used to classify cord insertion as normal, marginal, or velamentous. RESULTS: Cord insertion was abnormal in 66.7% of the fetuses with umbilical hypocoiling but in only 1.3% of those whose coiling index was > or = 0.1 (p < 0.05). CONCLUSIONS: Hypocoiling of the umbilical cord was highly associated with abnormal cord insertion. The presence of a hypocoiled umbilical cord may indicate the presence of abnormal cord insertion and thus may be useful for obstetric management.     

Assessment of umbilical cord coiling during the routine fetal sonographic anatomic survey in the second trimester.

OBJECTIVE: The purpose of this study was to evaluate the sonographic accuracy to determine the umbilical coiling index (UCI) during the routine fetal anatomic survey in the second trimester. METHODS: In 300 consecutive women with singleton pregnancies and absence of gross fetal anomalies who had a routine second-trimester fetal anatomic survey, a distance between 2 pairs of coils was measured from the longitudinal images of the umbilical cord, and the antenatal UCI (aUCI) was calculated. The aUCI was compared with true UCI results obtained after birth. RESULTS: Two hundred thirty-six patients had adequate sonographic umbilical cord images, and all required demographic, antenatal, and labor data collection to meet the inclusion criteria. A statistically significant correlation between aUCI and true UCI was found (P < .0001; r = 0.643). The mean aUCI was 0.402 (80% confidence interval, 0.382), and the true UCI at birth was 0.203 (80% confidence interval, 0.176). The sonographic evaluation showed 12.3% and 8.9% of hypocoiled and hypercoiled cords, whereas evaluation at birth found 10.6% and 8.1% hypocoiled and hypercoiled umbilical cords, respectively. The sensitivity values of sonography to predict hypocoiling and hypercoiling at birth were 78.9% and 25.4%, respectively. CONCLUSIONS: A sonographic evaluation of umbilical cord coiling in the second trimester correlates with the true UCI at birth, although the sensitivity in predicting coiling patterns as hypocoiled and hypercoiled cords is less accurate. A difference between the aUCI and matched UCI at birth could be explained by a sonographic error in the sampling of different umbilical cord segments with discordant coiling patterns or the possibility of a dynamically evolving UCI with advancing gestational age.     

Absence of a relationship between umbilical cord thickness and coiling patterns.

OBJECTIVE: The purpose of this study was to evaluate a relationship between the umbilical cord thickness and cord coiling patterns during the fetal sonographic anatomic survey in the second trimester of pregnancy. METHODS: This was a prospective study of 470 patients with singleton pregnancies who had a fetal anatomic survey with recorded umbilical coiling patterns between 18 and 23 weeks' gestation. The umbilical cord thickness was assessed as an umbilical diameter at the level of the fetal abdominal cord insertion and compared with the antenatal umbilical coiling index (aUCI), calculated as a reciprocal value of the distance between a pair of umbilical cord coils. RESULTS: Three hundred twenty-one patients had adequate sonographic umbilical cord images and maternal demographic, antenatal, and labor data to meet inclusion criteria. The mean aUCI was 0.41 with 10th and 90th percentiles of 0.21 and 0.60, respectively. A total of 10.6% (34/321) and 9.3% (30/321) of patients were categorized as having hypocoiled and hypercoiled umbilical cords, respectively. The mean cord diameter +/- SD was 9.48 +/- 0.97 mm (range 7.0-12.5 mm). There was no statistically significant correlation between aUCI and umbilical cord thickness (P = .1164). CONCLUSIONS: An aUCI, or umbilical coiling pattern, does not correlate with umbilical cord thickness. It appears that a lesser amount of the umbilical supportive tissue, mainly Wharton jelly, is not related to an increased umbilical cord coiling pattern.     

Second-trimester ultrasonographic assessment of the umbilical coiling index.

OBJECTIVE: To determine the relationship between gestational age and the ultrasonic measurement of umbilical coiling index (UCI), and to assess the ability of second-trimester ultrasonic measurements of UCI to predict the true UCI, determined at birth. SUBJECTS/METHODS: Five hundred and thirty-one consecutive women with uncomplicated pregnancies, booking for delivery with a singleton pregnancy, were recruited during a routine second-trimester fetal morphology scan. Multiple ultrasonographic measurements of the intercoil distance were performed between two to three coils of the umbilical cord, along its entire visible length. Three hundred and seventy-four patients (70%) were followed until delivery when the true UCI was measured. RESULTS: An adequate portion of umbilical cord for assessment of coiling was visualized in 99% of cases. Adequate ultrasonographic visibility rates for the fetal, middle and placental regions of the cord were different. All three regions of the umbilical cord could only be visualized adequately in 10% of cases, and two regions were visible in 75%. The UCI progressively decreased along the cord from the fetal insertion to the placental insertion. The mean decrease in UCI with increasing gestational age was similar in all parts of the cord before the 23rd week (160 days) of pregnancy, and plateaued off after this point, except in measurements performed near the fetal insertion. The sensitivity of second-trimester ultrasound examination for predicting hypercoiling at birth was 17.3% and for predicting hypocoiling was 9.1%. DISCUSSION: Whilst UCI can be measured easily and reliably in the second trimester these estimates do not accurately reflect the UCI at term. Our original assumption that umbilical coiling does not alter after the initial formation of coils in the first trimester is incorrect; mixed patterns occurred in about 25% of cases. These patterns develop during the second and third trimesters, presumably due to snarls in the cord, and influence the final coiling number and therefore the relationship between the two measurements of UCI.     

First-trimester umbilical cord diameter: a novel marker of fetal aneuploidy.

OBJECTIVE: To compare the umbilical cord diameter at 10-14 weeks of gestation of chromosomally normal and abnormal fetuses. METHODS: In a consecutive series of women, who were undergoing routine sonographic evaluation at 10-14 weeks of gestation, umbilical cord diameter and nuchal translucency were measured. Reference ranges for umbilical cord diameter according to gestational age and crown-rump length were constructed. Fetal karyotype was obtained at chorionic villus sampling, amniocentesis or at delivery in newborns with features suspicious for chromosomal abnormalities. RESULTS: During the study period, 784 patients met the inclusion criteria. Of these, a fetal or placental chromosomal abnormality was present in 17 cases. The mean umbilical cord diameter increased with gestational age (r = 0.41, P < 0.001).The proportion of fetuses with an umbilical cord diameter above the 95th centile was higher in the presence of fetal or placental chromosomal abnormalities than in normal fetuses (5/17 vs. 39/767, P < 0.01). Among fetuses with an abnormal fetal or placental karyotype, nuchal translucency was above the 95th centile for gestational age in 10 cases.When only fetal chromosomal abnormalities were considered (n = 14), the combined detection rate was 85.7%(12/14). CONCLUSIONS: Sonographic assessment of the umbilical cord in early gestation appears to identify a subset of fetuses at increased risk of chromosomal abnormalities.     

Umbilical vein blood flow in fetuses with normal and lean umbilical cord.

OBJECTIVE: To evaluate whether umbilical vascular coiling is correlated with the umbilical vein blood flow profile and to investigate if this is different between fetuses with a lean and those with a normal umbilical cord. METHODS: Consecutive women with a singleton gestation who delivered at term and who underwent an ultrasound examination within 24 h from delivery were studied. Umbilical cord and vessel areas were calculated. Umbilical vein blood flow parameters were obtained by digital color Doppler velocity profile integration. After delivery, the umbilical coiling index was calculated. RESULTS: One hundred and sixteen women were studied. Twelve (10.3%) had a lean umbilical cord (area < 10th centile). A significant correlation was found between the umbilical coiling index and the umbilical vein blood flow (r = 0.67, P < 0.001). A significant difference between fetuses with and without a lean cord was found in terms of: umbilical coiling index (0.18 +/- 0.08 vs. 0.29 +/- 0.09, P < 0.005), cord area (87.6 +/- 5.1 mm2 vs. 200.6 +/- 34.6 mm2, P < 0.001), Wharton's jelly amount (25.7 +/- 10.3 mm2 vs. 122.1 +/- 33.4 mm2, P < 0.001), umbilical vein blood flow (93.7 +/- 17.8 ml/kg per min vs. 126.0 +/- 23.4 ml/kg per min, P < 0.001), and umbilical vein blood flow mean velocity (6.6 +/- 2.7 cm/s vs. 9.0 +/- 3.6 cm/s, P < 0.05). The proportion of fetuses with an umbilical vein blood flow < 80 ml/kg per min was higher when the cord was lean than when it was normal (25% vs. 1.9%, P < 0.01). CONCLUSIONS: Lean umbilical cords differ from normal cords not only from a structural point of view but also in the umbilical vein blood flow characteristics. This could explain the increased incidence of intrapartum complications and fetal growth restriction among fetuses with a lean and/or hypocoiled cord.     

Middle cerebral artery blood flow velocimetry among healthy fetuses with a single umbilical artery.

OBJECTIVE: A single umbilical artery (SUA) is an independent risk factor for perinatal morbidity and mortality in healthy fetuses. The aims of the study were (1) to determine middle cerebral artery (MCA) blood flow velocimetric values among fetuses without structural or chromosomal anomalies with an SUA and to compare them with nomograms of patients with a 3-vessel cord and (2) to measure the pulsatility index (PI) of the umbilical artery among these patients. METHODS: The PI values of the MCA and umbilical arteries were determined prospectively among 98 healthy fetuses with an SUA. The PI values were compared with nomograms of patients with a 3-vessel umbilical cord. For the MCA, peak systolic velocity (PSV) was also measured. Patients carrying fetuses with intrauterine growth restriction or congenital anomalies were excluded from the study. Middle cerebral artery PI values below the fifth percentile and PSV values above the 95th percentile adjusted for gestational age were considered abnormal. RESULTS: Gestational age ranged between 22 and 37.9 weeks (median, 30.3 weeks). After adjusting for gestational age, no alterations in the MCA PI and umbilical PI were found in comparison with the normal range for a 3-vessel cord known in the literature. Middle cerebral artery PSV values were also within the normal range for gestational age in all patients. CONCLUSIONS: The MCA PI and PSV values among healthy fetuses with an isolated SUA were similar to nomograms for fetuses with a 3-vessel umbilical cord. Therefore, abnormal MCA PI and PSV values among fetuses with an SUA should be treated the same as in patients with a 3-vessel umbilical cord.     

Umbilical cord morphologic characteristics and umbilical artery Doppler parameters in intrauterine growth-restricted fetuses.

OBJECTIVE: To compare prenatal morphometric changes of umbilical cord components in intrauterine growth-restricted fetuses with and without abnormal umbilical artery Doppler parameters. METHODS: Consecutive singleton intrauterine growth-restricted fetuses at a gestational age of older than 20 weeks were compared with matched appropriate-for-gestational-age fetuses. Intrauterine growth restriction was defined in the presence of a sonographic abdominal circumference below the 5th percentile for gestational age at the time of sonography and a birth weight below the 10th percentile. The sonographic examination included pulsed Doppler measurements of the umbilical artery resistance index and measurements of the umbilical cord cross-sectional area and the umbilical cord vessel area. RESULTS: A total of 84 intrauterine growth-restricted fetuses and 168 appropriate-for-gestational-age fetuses were included in the study. All umbilical cord components (umbilical cord cross-sectional area, vein area, artery area, and Wharton jelly area) were smaller in the intrauterine growth-restricted fetuses. The prevalence of lean umbilical cords (cross-sectional area < 10th percentile for gestational age) was significantly higher in intrauterine growth-restricted fetuses compared with appropriate-for-gestational-age fetuses (73.8% versus 11.3%; P < .0001). A significant and progressive reduction of the umbilical vein area corresponding to the degree of umbilical artery Doppler parameter abnormality was found. The umbilical artery area was not related to the hemodynamic changes of the blood flow in the umbilical arteries. CONCLUSIONS: The proportion of lean umbilical cords was higher in intrauterine growth-restricted fetuses than in appropriate-for-gestational-age fetuses. Umbilical vein caliber decreases significantly with worsening of umbilical artery Doppler parameters.     

Fetal aneuploidy and umbilical cord thickness measured between 14 and 23 weeks' gestational age.

OBJECTIVE: To evaluate and compare umbilical cord thickness of aneuploid fetuses with umbilical cord diameter nomograms generated from euploid fetuses between 14 and 23 weeks' gestational age. METHODS: A retrospective study was conducted in which 56 fetuses and neonates had diagnoses of abnormal karyotypes, of which 46 fetuses had numerical chromosomal abnormalities. Among these cases, 26 subjects with adequate umbilical cord sonographic images were included in the study. The umbilical cord thickness was measured and plotted against the umbilical cord diameter nomogram that was generated from previously published data. RESULTS: From 26 evaluated fetuses and neonates, in 14 subjects (53.8%), the umbilical cord thickness was greater than the 95th percentile for gestational age. A thick umbilical cord was observed in 57.8% of fetuses with trisomy 21 and 50% of subjects with trisomy 18 and monosomy 45,XO. One fetus with trisomy 2 had umbilical cord thickness within the normal range. The largest number of aneuploid fetuses with thick umbilical cords (87.5%) was observed between 16 and 17 gestational weeks. CONCLUSION: Aneuploid fetuses have thicker umbilical cords than euploid fetuses. The umbilical cord thickness can be related to an increased amount of Wharton jelly. Because of the smaller number of thick umbilical cords in aneuploid subjects at later gestational ages, we speculate that abnormal cord thickness has a natural tendency toward its own resolution with the advancement of gestational age.     

Sonographic umbilical vessel morphometry and perinatal outcome of fetuses with a lean umbilical cord

PURPOSE: This study was undertaken to assess whether changes in umbilical cord vessel morphometry are associated with an increased risk of adverse perinatal outcome among fetuses with a lean umbilical cord on sonography. PATIENTS AND METHODS: A total of 160 fetuses with a sonographically lean umbilical cord (cross-sectional area below the 10th percentile for gestational age) after 20 weeks of gestation were enrolled. The cross-sectional areas of the umbilical cord and its vessels were measured. Outcome variables investigated were perinatal death, admission to the neonatal intensive care unit, intrauterine growth restriction, and 5-minute Apgar score. RESULTS: The proportions of perinatal death (1/96 versus 6/64, p < 0.05) and admission to the neonatal intensive care unit (17/96 versus 22/64, p < 0.05) was significantly higher among fetuses with an umbilical vein area below or equal to the 10th percentile for gestational age than among those with an umbilical vein area greater than the 10th percentile. No differences were found in the proportions of perinatal death, neonatal intensive care unit admission, 5-minute Apgar score < 7, and intrauterine growth restriction when fetuses with umbilical vein areas below or equal to the 10th, the 5th, and the 2.5th percentiles for gestational age were compared. No difference was found in the umbilical artery area and Wharton's jelly area among the groups. CONCLUSION: Among fetuses with a sonographically lean umbilical cord, a significant relationship exists between an umbilical vein area below or equal to the 10th percentile and an adverse neonatal outcome.