超声诊断脐带异常与绕颈一周压迹深度的意义

Clinical significance of ultrasonic scanning in detecting umbilical abnormality and measuring notch depth of nuchal cord entanglement

对本院门诊及住院部妊娠≥28周共10 944例孕妇行B超检查、胎心监护,分娩时记录羊水、脐带及新生儿情况.脐带异常发生率31.51%（3448/10 944）,B超诊断脐带异常的敏感度为95.74%（3301/3448）,特异度为96.25%（7215/7496）.脐带异常者剖宫产率（44.00%）、胎儿窘迫率（18.27%）、Apgar评分≤7分率（15.46%）、死胎率（2.41%）显著高于无脐带异常者（均P＜0.01）;脐带绕颈1周压迹深度≥0.8 cm者剖宫产率（41.90%）、胎儿窘迫率（29.76%）、Apgar评分≤7分率（25.30%）、死胎率（4.05%）显著高于压迹＜0.8 cm者（均P＜0.01）.B超在诊断脐带异常的种类、指导分娩方式的选择及提高围生儿预后方面均具有重要意义.

Type B ultrasonic scanning was performed routinely for 10 944 pregnant women at their third semester when they visited outpatient department or were admitted to our hospital during January 2004 to December 2008, and their fetal heart rate, amniotic fluid, umbilical cord and neonate conditions were monitored and recorded during delivery. The sensitivity and specificity of type B ultrasonic were 95.74% （3301/3448） and 96. 25 % （7215/7496）. Umbilical abnormality was diagnosed in 3448 pregnancies by type B ultrasonic scanning, with prevalence of 31.51%, cesarean section was performed in 44.00 %, fetal distress occurred in 18. 27% of them, 15.46% of them with Apgar score equal to or less than seven, and fetal death occurred in 2. 41% of them, all significantly higher than those in pregnant women without umbilical abnormal （23. 77%, 8. 56%, 7.84% and 1.36%, respectively, all P 〈0. 01 ）. Cesarean section was performed in 41.90 % of those with 0. 8 cm or more in the notch depth of nuchal cord entanglement,fetal distress occurred in 29.76% of them, 25.30% of them with Apgar score equal to or less than seven and fetal death occurred in 4. 05% of them, all significantly higher than those in pregnant women with the notch depth less than 0. 8 cm （20. 22%, 8. 60%, 9. 26% and 0. 54%, respectively, all P 〈0. 01 ）. Type B ultrasonic scanning plays an important role in clinical diagnosis for umbilical abnormality, guiding selection of delivery method and improving neonatal prognosis.