超声诊断胎儿脐带缠绕的临床意义

The clinical significance study of the ultrasonic diagnosis for fetal umbilical cord entanglement

目的 对中晚期孕妇进行胎儿脐带检测,提高产前胎儿脐带缠绕的诊断率,帮助临床选择正确的分娩方式,尤其在临产后密切观察及时发现胎儿宫内窘迫.方法 对孕30～42周1 060例经超声诊断胎儿脐带缠绕的孕妇,进行复查及产后随访.结果 1 060例经超声诊断为胎儿脐带缠绕的孕妇中脐绕颈1016例,占95.8％,其中1周发生764例,2周发生229例,3周发生19例,4周发生4例;缠绕腹背部8例,占0.8％;缠绕大腿及小腿部6例,占0.6％;1 060例中误诊及漏诊30例,占2.8％.超声诊断胎儿脐带缠绕的准确率97.2％.脐带缠绕的声像图显示胎儿脐带绕颈1周,为颈部皮肤为“U”或“V”压迹,2周胎儿颈部皮肤为“W”形压迹,3周胎儿颈部皮肤为“WV”形压迹,4周为波浪形态;脐带缠绕腹背部及下肢处,在相应部位可见“U”或“W”形压迹.脐带缠绕处,横断面可见红蓝相间的环状血流束呈螺旋状,形似“麻花”,如缠绕过紧,S/D比值升高.结论 超声对胎儿脐带缠绕的灵敏度提高,为临床选择分娩方式提供了可靠的依据.

Objective To study the clinical significance of the ultrasonic diagnosis for fetal umbilical cord entanglement. To improve the diagnosis of prenatal fetal umbilical cord entanglement, and help clinical choose the correct way of delivery, especially after the birth closely observe fetal distress in time. Methods A total of 1060 pregnant women for 30-42 weeks of ultrasound diagnosis of fetal umbilical cord entanglement were included. All pregnant women were reviewed and postnatal follow-up. Results A total of 1 016 cases were umbilical cord entanglement neck, accounting for 95.8%. with 764 cases happened a week, 229 cases happened two weeks, 19 cases happened three weeks, 4 cases happened four weeks. 8 cases were umbilical cord entanglement abdomen and back, accounted for 0.8%. 6 cases were umbilical cord entanglement the thigh and calf, accounted for 0.6%. 30 cases were misdiagnosis and missed diagnosis, accounted for 2.8%. The accuracy rate of ultrasonic diagnosis for fetal umbilical cord entanglement was 97.2%. The ultrasonographic showed that fetal umbilical cord around the neck a week the neck skin for ＂U＂ or ＂V＂ mark, two weeks the neck skin for ＂W＂ shape, three weeks the neck skin for the shape of ＂ WV＂, four weeks the neck skin for wave form. Umbilical cord entanglement under abdomen and back and lower limb, the ultrasonographic showed ＂U＂ or ＂W＂ shape. Umbilical cord entanglement, cross-sectional visible red, blue and white blood flow to annular beam spiraling, shaped like a ＂twist＂, such as wound too tight, the S/D ratio increased. Conclusion Ultrasonic can improve the sensi- tivity of fetal umbilical cord entanglement, and provide the reliable basis for clinical selection of childbirth way.