臀位脐带脱垂的临床特点及防治——附19例病例分析及文献复习

The breech delivery umbilical cord escapes the clinical characteristic and preventing and controlling which hangs (to attach 19 example cases of illness to analyze)

目的：探讨臀位脐带脱垂的临床特点及防治方法,降低围生儿死亡率。方法：分析近10年19例臀位脐带脱垂诊疗情况,复习近年文献,分析其临床表现、特征及防治方法。结果：综合文献臀位脐带脱垂发生率5.79%明显高于头位0.10%（P〈0.001）;臀位足先露较易发生脐带脱垂,其次为混合臀先露,单臀发生的最低;脐带长度〉70 cm较〈70 cm易发生脱垂（P〈0.05）;阴道分娩围生儿、新生儿死亡率分别为40.63%、50.00%,明显高于剖宫产的3.33%、8.33%（P〈0.001）;初产妇、经产妇臀位时脐带脱垂发生接近（P〉0.05）,脐带脱垂发生后胎心〈100次/min的比〉160次/min多（P〈0.05）;入院后发生脐带脱垂明显多于入院前（P〉0.05）,宫口开大4-6 cm时脐带脱垂发生多,其次为宫口开大〉7 cm,宫口开大1-3 cm较低。脐带脱垂行还纳、未还纳与围生儿、新生儿预后差异无统计学意义（P〉0.05）。结论：臀位脐带脱垂多发生在活跃期、多见于足先露、脐带过长者,发生率已明显降低,防治重在加强孕期监护和管理,降低臀位发生,正确选择分娩方式,剖宫产可有效降低围生儿死亡率,应适当放宽剖宫产指征。如果发生、应根据产程进展及胎心情况,采取最佳处理方法（剖宫产或臀牵引助产）终止妊娠,提高围生儿抢救成功率。

Objective： The discussion breech delivery umbilical cord escapes the clinical characteristic and the preventing and controlling method which hangs,reduces encircles produces the mortality rate.Method： Analyzed the near ten year 19 example breech delivery umbilical cord to escape hangs the diagnosing and treating situation,the review recent years the literature,analyzed its clinical manifestation and the characteristic,the discussion prevents and controls the method.Results： The breech delivery umbilical cord escapes hangs formation rate 5.79% to be higher than a position obviously 0.10%（P〈0.001）.The breech delivery first reveals fully easily to have the umbilical cord to escape hangs,next for mixes the buttocks to reveal first,the single buttocks occur lowly.Umbilical cord length 70 cm compares 70 cm easily to occur escapes hangs（P〈0.05）.The vagina childbirth encircles produces,the neonatal mortality rate respectively is 40.63%,50.00%,is higher than obviously splits 3.33% which the palace produces,8.33%（P〈0.001）.Initially parturient woman,after parturient woman breech delivery when the umbilical cord escapes hangs occurs close（P〈0.05）,the umbilical cord escapes hangs occurs a rear tire heart 100/min compared to a 160/min（P〈0.05）.After in hospital has the umbilical cord to escape hangs is more than before obviously in hospital（P〈0.05）,the palace mouth opens when big 4-6 cm the umbilical cord escapes hangs occurs many,next opens big 7 cm,the palace mouth for the palace mouth opens big 1-3 cm to be low.The umbilical cord escapes hangs the line also to accept,not to accept with encircles produces,the newborn prognosis not obvious difference（P〈0.05）.Conclusion： The breech delivery umbilical cord escapes hangs occurs in the active phase,sees footing presentation,the umbilical cord elder,the formation rate had reduced obviously,preventing and controlling again in the enhancement gestation period guardianship and the management,reduces the breech delivery occurrence,chooses the childbirth way correctly,splits the palace to produce may reduce effectively encircles produces the mortality rate,should relax suitably splits the palace to produce refers drafts.If has,should act according to the course of childbirth progress and the embryo heart situation,adopts the best processing method（to split palace to produce or buttocks hauling midwifery） terminated the pregnancy,enhances encircles produces the rescue success ratio.