头位脐带绕颈367例临床分析

A clinical analysis of 367 cases of pregnancy with nuchal cord and cephalic presentation

目的 :探讨脐带绕颈的诊断 ,监护时机及分娩方式的选择。方法 :回顾性分析我院住院的 36 7例头位脐带绕颈者的临床资料 ,本组脐带绕颈者无产科合并症及并发症。结果 :36 7例脐带绕颈者产前彩色B超诊断的准确率 93.7% (343/ 36 7)。阴道试产 2 39例 ,宫口开 5cm后产程停滞发生率83.2 % (6 2 / 74 ) ;胎儿窘迫发生率 2 6 .2 % ,宫口开 5cm至宫口开全 15min内占 79.2 % ,先露棘上 2cm至棘下 2cm占 6 8.2 % (4 3/ 6 3) ;临产时头先露未衔接与衔接组相比 ,产程停滞 ,胎儿窘迫 ,剖宫产率明显增高 ,P <0 .0 5 ,差异有显著性。而先露衔接组与择期剖宫产相比 ,胎儿窘迫 ,新生儿窒息 ,吸入性肺炎均无差异 (P >0 .0 5 )。结论 :彩色B超对晚期妊娠脐带绕颈的诊断是准确可靠的 ,应于宫口开 5cm后和 (或 )先露棘上 2cm以下密切监测产程进展 ,胎儿宫内情况 ,对于临产时先露衔接者可行阴道试产 。

Objective: To determine the diagnosis, surveillance and delivery method for pregnancies with nuchal cord and cephalic presentation. Method: Clinical data of 367 cases of pregnancy complicated with nuchal cord and cephalic presentation were analyzed retrospectively, no pregnancy complications had ever been found in the pregnancy women before delivery.Result: All nuchal cords were identified using prenatal color doppler with an accurate rate of 93.7%(343/367). Attempts at vaginal delivery were tried in 239 cases. Among them, 83.2% had protracted stage of labor which could be observed only when the cervical dilatation was at least 5cm; the incidence of fetal distress is 26.2 %,and 79.2% of which occurred when the cervical dilations from 5 cm to10 cm were within 15 minutes; 68.2% occurred when the presentation was at the level of -2s to +2 s. engagement in labor were associated with lower incidence of fetal distress, cesarean section and arrested stage of labor compared with none-engagement cases (p<0.05). However, the incidences of fetal distress, newborn asphyxia and aspiratory pneumonitis were not significantly differrent between the group of the engagement and that of the plannedcesarean section(p>0.05).Conclusion: For pregnancies with nuchal cord and cephalic presentation, careful surveillance of labor process as well as fetal status should be made after 5cm of cervical dilatation.and(or) -2s of presentation. If engagement in labor could be observed, vaginal delivery may be attempted; whereas, cesarean section was strongly recommended.