脐动脉血流变化对估计脐带绕颈胎儿预后的价值

The blood flow changes of umbilical artery in predicting perinatal outcome of fetus with nuchalcord

目的:探讨脐动脉血流变化对估计脐带绕颈胎儿预后的价值。方法:选取2003年1～9月足月妊娠妇女46例,其中观察组34例,均为脐带绕颈1周并经阴道分娩。结合胎儿预后将观察组分为胎窘组(10例)和正常组(24例)。对照组12例,为随机选择的同期正常妊娠并顺产的妇女。应用彩色多普勒超声技术对全部孕妇于临产前和活跃早期检测胎儿脐动脉阻力指标——收缩期峰值流速舒张末期流速(SD)、阻力指数(RI)和搏动指数(PI)。结果:①临产前胎儿UA血流SD、RI、PI值,胎窘组、正常组分别与对照组比较,差异均无显著性(P>0.05)。②活跃早期宫缩期和间歇期,胎儿UA血流SD、RI、PI值,胎窘组、正常组分别与对照组比较,差异均无显著性(P>0.05)。结论:产前及活跃早期监测脐动脉血流变化不是预测脐带绕颈胎儿不良预后的理想方法。

Objective： To investigate the value of blood flow changes of umbilical artery（UA） in predicting adverse outcome of fetuses with nuchaleord. Methods： From January 2003 to September 2003, 46 women who delivered at term were studied. Thirty-four of them who were complicated with nuchaleord and had vaginal deliveries were devided into two groups according to fetal outcome. Group 1 included 10 cases with fetal distress. Group 2 included 24 cases with favorable fetal outcome. A control group included 12 women who were healthy pregnant women without nuehal coiling of the umbilical cord and had normal vaginal deliveries. Before labour and during early-active labour, blood flow impedance of fetal umbilical artery was assessed by means of color Doppler ultrasonography and measured by the peak-systolic/diastolic ratio（S/D）, pulse index（PI） and resistance index（RI） during contraction and intermission respectively. Results： ①Before labour, the S/D, RI, PI values of fetal UA had no significant differences between the two groups（P〉0.05）. ②In early-active labour, the S/D, RI, PI values of fetal UA had no signifieant differences between the two groups（P〉0.05）. Conclusions： Examination of fetal blood flow in UA before labour and during early-active labour is not a valuable method in predicting adverse perinatal outcome of fetuses with nuchalcord.