1279例脐带缠绕临床分析

The clinical analysis on the umbilical cord entanglement of 1279 cases

目的探讨脐带缠绕的分娩方式与国生儿结局的关系。方法回顾性分析1279例脐带缠绕病例的分娩方式、产前知晓率、胎儿窘迫率及新生儿窒息率等情况；同期脐带缠绕组（1279例）与无缠绕组（2939例）比较剖宫产率、胎儿窘迫率及新生儿窒息率。结果脐带缠绕组中剖宫产的产前知晓率明显高于阴道分娩组（P〈0.01）；剖宫产组的胎儿窘迫率、新生儿窒息率与阴道分娩组比较无明显差异（P〉0.05）；剖宫产中脐带缠绕1周与2周比较、阴道分娩中脐带缠绕1周与2周比较，胎儿窘迫率、新生儿窒息率均无明显差异（P〉0.05），但剖宫产中脐带缠绕2周与阴道分娩中脐带缠绕2周比较，阴道分娩胎儿窘迫率高于剖宫产（P〈0.05），但新生儿窒息率无明显差异（P〉0.05）；脐带缠绕组与无缠绕组比较，缠绕组的剖宫产率、胎儿窘迫率、新生儿窒息率均比无缠绕组高（P〈0.01）。结论脐带缠绕可给围生儿带来不良影响，不同分娩方式新生儿结局无明显差异，故脐带缠绕不是剖宫产指征，只要加强监护，正确及时处理产程中的异常，仍然可以阴道分娩。

Objective To investigate the relationship between ways of delivery with umbilical cord entangle- ment and outcomes of perinatal infants. Methods The data of 1279 cases with umbilical cord entanglement was retroseptively reviewed about ways of delivery, antepartum awareness rate, as well as incidence of fetal distress and neonatal asphycsia. The incidence of cesarean section, fetal distress and neonatal asphyxia in the umbilical cord entanglement group （1279 cases） were compared with those in the non-entanglement group （2939 cases） during the same period. Results In umbilical cord entanglement group, the antepartum awareness rate was markedly higher among the cesarean section cases than that among the vaginal delivery cases （P 〈0.01）. The incidence of fetal distress and neonatal asphyxia among the cesarean section cases were not significantly different from those among the virginal delivery cases （P 〉0.05）. On comparison of one and two circles of entanglement, no significant difference was found among either cesarean section cases or vaginal delivery cases （P〉0.05）. The incidence of fetal distress with two cirlcs of entanglement was higher among virginal delivery cases than that among the cesarean section cases （P〈0.05）, while no significant difference was noted in terms of neonatal asphyxia （P〉0.05）. The incidences of cesarean section, fetal distress and neonatal asphyxia in the umbilical cord entanglement group were higher than those in the non - entanglement group （P〈0.01）. Conclusion Umbilical cord entanglement poses adverse effects on perinatal infants, and outcomes of infants did not vary significantly with different ways of delivery. Therefore, umbilical cord entanglement was not an indicator for cesarean section. Virginal delivery was warranted with intensified monitoring and timely proper management of abnormal stage of labor.