足月头位胎儿脐带绕颈212例临床分析

目的 探讨胎儿脐带绕颈发生的相关因素及对妊娠结局的影响,以指导临床处理原则.方法 随机抽取201 1年3月至2013年8月在暨南大学第四附属医院产检并分娩的孕妇212例为研究对象,将其按产前末次B超结果分组,无胎儿脐带绕颈的为对照组,胎儿脐带绕颈1周者为实验Ⅰ组,脐带绕颈2周及以上者为实验Ⅱ组（在分娩时均证实脐带绕颈情况与产前B超结果一致）.比较3组产妇的产前基本情况、脐带及胎盘情况、产前及产时相关并发症.结果 对照组及实验Ⅰ、Ⅱ组的新生儿体重、脐带长度差异有统计学意义（P＜0.05）;胎儿生长受限发生率、产时胎监异常发生率差异有统计学意义（P＜0.05）,但胎儿宫内窘迫、新生儿窒息的发生率差异无统计学意义（P＞0.05）.结论 存在胎儿脐带绕颈,产前需加强监护;脐带绕颈不是剖宫产指征,但应在产程过程中严密监测,以确保良好的妊娠结局.

Clinical Analysis of 212 Cases with Nnuchal Cord Entanglement in Head Presentation

Objective To explore the related factors that lead to umbilical cord entanglement around neck,to analyze the obstetric and neonatal outcomes of nuchal cord entanglement.Methods 212 pregnant women admitted in the Fourth Affiliated Hospital of Jinan University from March 2011 to May 2013 were selected randomly.They were divided into three groups according to the last prenatal ultrasonic Doppler：the control group （without cord around neck）,the experimental group Ⅰ （had one loop of cord around neck） and the experimental group Ⅱ （had two or more loops of cord around neck）.We compared the perinatal basal data,obstetric and neonatal outcomes.Results There were some differences in cord length and neonatal birth weight between the three groups （P＜0.05）,and the incidence of fetal growth restriction and intrapartum abnormal fetal heart were higher in the two experimental groups （P＜0.05）,but fetal distress rate and neonatal asphyxia rate did not have obvious differences.Conclusion There are no evidences proving that pregnant women with nuchal cord entanglement need cesarean delivery,but we must closely monitor the baby in prenatal and intrapartum period to guarantee a good result.