脐血流多普勒超声联合B超在产前诊断脐绕颈中的应用

目的：探讨脐血流多普勒超声联合Ｂ超对产前诊断脐绕颈的价值。方法：对我院１９９４年１０月～１９９６年１０月住院分娩的３４０例正常足月妊娠妇女进行了Ｂ超及脐血流多普勒超声检查。结果：Ｂ超产前诊断脐绕颈率为５６．７５％，Ｂ超联合脐血流多普勒超声使脐绕颈的检出率提高到７３．８７％，二者联合对脐绕颈阴性的预测率为８７．１１％。根据产后情况分正常组（２２９例）和脐绕颈组（１１１例），比较两组间脐动脉收缩期血流速度峰值与舒张期血流速度峰值的比值（Ｓ／Ｄ）、脐动脉搏动指数（ＰＩ）、脐动脉阻力数（ＲＩ），发现两组间Ｓ／Ｄ值差异有显著性（Ｐ＜０．０５）且与脐带长度有关，脐绕颈组中，脐带长度≤５０ｃｍ组分别与正常组和脐长７０ｃｍ以上的脐绕颈组比较，Ｓ／Ｄ、ＲＩ值差异均有显著性（Ｐ＜０．０１、Ｐ＜０．０５）。结论：脐绕颈时，产前已有脐带轻度受压。脐绕颈及绕颈后脐带相对过短均为脐带受压的主要原因。脐血流多普勒超声与Ｂ超结合，既可提高脐绕颈的产前检出率，也可在一定程度上估计胎儿宫内安危。

The Application of Umbilical Artery Doppler Ultrasound and B Ultrasonography in the Prenatal Diagnosis of Umbilical Cord Round the Neck

Objective: To evaluate the umbilical artery Doppler velocimetry combined with B ultrasonography performed on 37～42 weeks gestation women for predicting umbilical cord round the neck (UCRN) Methods: Umbilical arterial systolic/diastolic(S/D),pulsatility index (PI),resistance index(RI) combined with monitoring of B ultrasonography of 340 cases 37～42 weeks normal pregnant women was studied by using umbilical artery Doppler velocimetry.340 pregnant women was divided into two groups according to the pregnancy outcome:229 cases in normal groups and 111 cases in UCRN group. Results:The S/D ratio in UCRN group was significantly higher than that in normal group (P<0.05). The S/D ratio and RI in 42 cases of UCRN whose umbilical length within 50 cm were significantly higher than who’s in normal group (P<0.01) and 21 cases of CURN who’s umbilical length over 70 cm (P<0.05).The incidence of intrapartum fetal distress in UCRN group was significantly higher than that of normal group. The diagnostic rate of UCRN,was 73.87%. Conclusion: The umbilical artery Doppler velocimetry may be useful as an adjunct in prenatal diagnosis of UCRN and assessing fetal health.