脐带绕颈对分娩方式及围生儿结局的影响

Influence of umbilical cord around neck on delivery mode and perinatal outcomes in vaginal delivery

目的观察脐带绕颈阴道试产对孕产妇分娩方式及围生儿结局的影响。方法选取在常州市新北区三井街道社区卫生服务中心就诊的108例存在胎儿脐带绕颈的孕产妇做为观察组,同期86例健康无胎儿脐带绕颈的孕产妇为对照组,两组均行阴道试产,观察并分析两组孕产妇分娩方式以及胎儿宫内窘迫、新生儿窒息、胎儿病死等发生情况。结果①观察组剖宫产率显著高于对照组(x^2=4.999,P<0.05),脐带绕颈≥2周的剖宫产率明显高于绕颈1周者(x^2=16.883,P<0.01),脐带绕颈≥2周的剖宫产率与对照组比较有显著性差异(x^2=22.554,P<0.01),脐带绕颈1周的剖宫产率与对照组比较无显著性差异(x^2=0.756,P=0.385);②观察组中胎儿宫内窘迫发生率和新生儿窒息发生率与对照组比较均有显著性差异(x^2=3.874,P=0.049<0.05;x^2=4.692,P=0.030<0.05),两组病死率比较无显著性差异(P=1.000);脐带绕颈≥2周的宫内窘迫发生率和新生儿窒息发生率均高于脐带绕颈1周者(x^2=24.233,P=0.000;x^2=28.524,P<0.01),两组病死率比较无显著性差异(P=0.185);脐带绕颈1周者与对照组比较,胎儿宫内窘迫率、新生儿窒息率均无显著性差异,P值分别为0.749和0.786,两组病死率均为0;脐带绕颈2周者与对照组比较,胎儿宫内窘迫、新生儿窒息均有显著性差异,x^2值分别为24.492和30.631,均P<0.01),两组病死率比较无显著性差异(P=0.189)。结论脐带绕颈≥2周对围生儿有不良影响,临床需谨慎选择正确的分娩方式,而绕颈1周者完全可阴道分娩。

Objective To observe the influence of umbilical cord around neck on delivery mode and perinatal outcomes in vaginal delivery. Methods A total of 108 pregnant women with fetal umbilical cord around neck visiting Changzhou Xinbei Sanjing Urban Health Center were selected in observation group, and 86 healthy cases without fetal umbilical cord around neck were chosen in control group. Both groups accepted trial of labor. The mode of delivery and the incidence of fetal distress, neonatal asphyxia and fetal death were observed and analyzed in two groups. Results The cesarean section rate of the observation group was significantly higher than the control group （χ2 =4. 999,P〈0. 05）, and that of the cases with umbilical cord around neck≥2 circles was significantly higher than those with umbilical cord around neck for 1 circle （χ2 =16. 883, P〈0. 01）. The cesarean section rate of the cases with umbilical cord around neck≥2 circles was statistically different from that of the control group （χ2 =22. 554, P〈0. 01）, but there was no obvious difference in the cesarean section rate between cases with umbilical cord around neck for 1 circle and the control group （χ2 =0. 756, P=0. 385）. The differences in the incidence of fetal intrauterine distress and neonatal asphyxia between two groups were significant （χ2 value was 3. 874 and 4. 692, respectively, both P〈0. 05）, but the difference in mortality was not significant （P=1. 000）. The incidence of fetal intrauterine distress and neonatal asphyxia in cases with umbilical cord around neck≥2 circles was higher than that in cases with umbilical cord around neck for 1 circle （χ2 =24. 233,P=0. 000;χ2 =28. 524,P〈0. 01）, but there was no significant difference in mortality （P=0. 185）. Compared with the control group, the incidence of fetal intrauterine distress and neonatal asphyxia in cases with umbilical cord around neck for 1 circle was not remarkably different （P value was 0. 749 and 0. 786, respectively）, and the mortality of two groups was 0. The incidence of fetal intrauterine distress and neonatal asphyxia in cases with umbilical cord around neck≥2 circles were significantly different from the control group （χ2 value was 24.492 and 30. 631, respectively, both P〈0. 01）, and the mortality was not significantly different （P=0. 189）. Conclusion Umbilical cord around neck≥2 circles has adverse effects on perinatal infants, so correct mode of delivery should be carefully chosen in clinics. Cases with umbilical cord around neck for 1 circle can take vaginal delivery.