胎儿脐血流检测及胎头下降试验对脐带绕颈的产前诊断及围产儿预后预测价值

The value of umbilical blood stream examination and descending test of fetal head on antenatal diagnosis of cord around neck and perinatal prognosis

目的:探讨胎儿脐血流检测及胎头下降试验对脐带绕颈的诊断及预测其胎儿预后的价值.方法:2001年1月～2004年6月随机选择住院分娩产妇3 208例,产前1周至少做1次脐血流检测,对胎头未衔接脐带绕颈孕妇行胎头下降试验,测定脐动脉血流指数.结果:3 208例孕妇产前诊断脐带绕颈770例,实际发生脐带绕颈738例.738例脐带绕颈孕妇S/D值异常者166例,产后证实胎儿窘迫150例.其中胎头浮动、S/D值正常者178例,均行胎头下降试验,22例出现阳性结果,产后证实发生胎儿窘迫30例.补加胎头下降试验后,阴性预测值及敏感度提高有显著性差异(P＜0.05).其阳性预测值、阴性预测值、敏感度、特异度及准确率分别高达91.49%、98.55%、95.56%、97.13%、96.75%.结论:胎儿脐血流检测及胎头下降试验,是产前诊断脐带绕颈及预测其围产儿预后的理想方法.

Objective： To study the value of umbilical blood stream examination and descending test of fetal head on antenatal diagnosis of cord around neck and perinatal prognosis. Methods： During January 2001 -June 2004, umbilical blood streams of 3 208 pregnant women randomly selected were examined at least once one week before labour. The pregnant women diagnozed not engagement and cord around neck received descending test of fetal head and umbilical artery blood stream index to determine index of umbilical blood streams. Results： Of 770 cases diagnosed as cord around neck, 738 were proved. Among the 738 cases, abnormal S/D 166 cases, 150 cases were proved fetal distress after delivery; floating fetal heads and normal S/D 178 cases, 22 cases were positive descending test of fetal head and 30 cases were proved fetal distress after＇ delivery. There was significant difference in negative predictive value and sensitivity after decending test of fetal head （P 〈 0.05） . The positive predictive value, negative predictive value, sensitivity, specificity and accuracy were 91.49%, 98. 55%, 95.56%, 97. 13% and 96. 75%, respectively. Conclusion： Umbilical blood stream examination and descending test of fetal head are the ideal methods for antenatal diagnosis of cord around neck and perinatl prognosis.