NST时减速波型结合B超在脐带缠绕诊断及预后评价中的作用

目的 :探讨 NST时减速波型结合 B超在脐带缠绕产前诊断及预后评价中的作用。方法 :选择入院时未临产的足月单胎头位妊娠 710例进行超声及胎儿监护检查 ,预测脐带缠绕的发生。并对比分析脐带缠绕病例中 NST时减速波型组与非 NST时减速波型组的围产儿病率及剖宫产率。结果 :足月单胎头位的脐带缠绕发生率为 2 4 .2 % ,初产妇高于经产妇 ,分别为 2 5 .6 7%及 18.8%。 NST时减速波型结合 B超预测脐带缠绕的阳性预测值为 84 .36 % ,阴性预测值为 96 .0 5 % ,敏感度为 87.79% ,特异性为 94 .8% ,准确率为 93.1%。 NST时减速波型组与非减速波型组比较 ,前者重度羊水污染率、胎儿窘迫率及剖宫产率高于后者 ,P<0 .0 5 ,P<0 .0 5 ,P<0 .0 2 5。而新生儿窒息率无明显差别 ,P>0 .0 5。结论 :NST时减速波型结合 B超预测脐带缠绕有较高准确率及预测值 ,可作为临床预测脐带缠绕的方法。对 NST时减速波型者适当放宽手术指征 ,能有效降低新生儿窒息率及死亡率

Value of combined application of fetal heart rate deceleration during nonstress testing and ultrasonography on diagnosis of umbilical cord entanglement and prediction of fetal outcome

Objective:To explore the function of combined application of fetal heart rate deceleration during nonstress testing (NST) and ultrasonography on diagnosis of antepartum umbilical cord entanglement and prediction of fetal outcome.Methods:710 cases of pregnant woman in singleton pregnancy with head birth between gestational ages of 37~42 weeks are selected before delivery by NST and ultrasonography to predict umbilical cord entanglement. The perinatal morbility and the incidence of cesarean section among the group with umbilical cord entanglement who show fetal heart rate deceleration or not are analysized.Results:The prevalence rate of umbilical cord entanglement in singleton pregnancy with head birth was 24.2%, which is higher in a primigraviola than that in a multigravidae, was 25.67% and 18.8%. Postive predict value of combined application of fetal heart rate deceleration during NST and ultrasonography was 84.36%, negative value was 95.05%, sensitivity was 87.79%,specificity was 94.8%, the rate of accuracy was 93.1%. the severe meconium-stained amniotic fluid, the rate of fetal distress and the incidence of cesarean section in this group with fetal heart rate deceleration during NST was significantly higher than that in this group without fetal heart rate deceleration during NST(P<0.05, P<0.05, P<0.025). There was no obvious difference in the morbility of neonatal asphyxia( P>0.05).Conclusion:Because the combined application of NST and ultrasonography predict the umbilical cord entanglement has better accuracy, it can be a good way to diagnose the umbilical cord entanglement. The index of cesarean section should be widen when there was fetal heart rate deceleration during NST, which can decrease the rate of neonatal asphyxia and death.