单纯性单脐动脉足月分娩的围产结局

Perinatal outcomes of isolated single umbilical artery in full-term birth

目的：探讨单胎妊娠、足月分娩的单纯性单脐动脉胎儿的围产结局。方法2011年1月1日至2012年1月1日，全国14个城市的39所医院的孕妇中，共82252例符合以下纳入标准：分娩年龄＜35岁、单胎妊娠、足月妊娠（分娩孕周≥37周）、活产、胎儿无结构异常及染色体异常。其中单纯性单脐动脉273例，按1︰4比例从其余病例中随机抽取1092例为对照组。回顾性分析孕妇的基本情况、分娩孕周及分娩方式（阴道分娩、因胎儿因素急诊剖宫产）；分析新生儿出生体重、出生身长、胎盘重量、脐带长度、生后1 min Apgar评分及窒息发生率。采用χ2检验、独立样本t检验和秩和检验进行统计学分析。结果单纯性单脐动脉发生率为0.3%（273/82252）。单纯性单脐动脉组与对照组孕妇的年龄、孕次、产次、是否吸烟、妊娠期糖尿病发生率、妊娠期高血压疾病发生率及分娩孕周比较，差异均无统计学意义（P值均＞0.05）。单纯性单脐动脉组与对照组新生儿的出生体重分别为（3259±463）与（3344±411） g（t=3.689），出生身长分别为（48.6±2.7）与（49.7±1.9） cm（t=8.368），胎盘重量分别为（508±72）与（543±153） g （t=3.114），脐带长度分别为（52.6±8.1）与（53.7±7.5） cm（t=1.983），生后1 min Apgar评分分别为9.0（8.0-10.0）与10.0（9.0-10.0）分（Z=11.831），单纯性单脐动脉组均低于对照组，差异有统计学意义（P值均＜0.05）。单纯性单脐动脉组与对照组孕妇的阴道分娩率[52.8%（144/273）与49.9%（545/1092），χ2=0.704]和因胎儿因素急诊剖宫产率[19.4%（25/273）与15.7%（86/1092），χ2=1.162]比较，差异均无统计学意义（P值均＞0.05）。结论单纯性单脐动脉不增加因胎儿因素急诊剖宫产率，但胎儿的生长发育可能落后于正常胎儿，妊娠期及分娩时应加强监护。

Objective To investigate the perinatal outcomes of isolated single umbilical artery （ISUA） in full-term birth. Methods We performed a retrospective study of 82 252 pregnant women （aged〈35 years;singleton; full-term live birth; no known chromosomal/structural anomalies） who delivered between January 1, 2011 and January 1, 2012 in 39 hospitals in 14 cities in China. There were 273 cases with ISUA as study group and 1 092 cases with a three-vessel cord selected in a 1∶4 ratio as control group. Perinatal outcomes including delivery modes （vaginal delivery or emergency cesarean section for fetal reasons）, birth weight and height, placental weight, umbilical cord length, Apgar scores at 1 min, and rate of neonatal asphyxia were analyzed retrospectively. Data were analyzed using the Chi-square test, two independent samples t-test or rank sum test. Results The incidence of ISUA was 0.3%（273/82 252）. There was no difference between the two groups with regard to maternal age, parity, gravidity, smoking status, gestational age at birth, or rate of complications during pregnancy （gestational diabetes mellitus or pregnancy-induced hypertension） （all P〉0.05）. The birth weight in ISUA group and control group was （3 259±463） and （3 344±411） g （t=3.689）, birth hight was （48.6±2.7） and （49.7±1.9） cm （t=8.368）, placental weight was （508±72） and （543±153） g （t=3.114）, umbilical cord length was （52.6±8.1） and （53.7±7.5） cm （t=1.983）, and Apgar scores at 1 min were 9.0 （8.0-10.0） and 10.0 （9.0-10.0）＆amp;nbsp;（Z=11.831）, respectively; the values in the ISUA group were lower than those in control group （all P 〈 0.05）. No significant differences were observed in the rate of vaginal delivery and emergeny cesarean section for fetal reasons between the ISUA group and control group [52.8%（144/273） and 49.9%（545/1 092）,χ2=0.704;19.4%（25/273） and 15.7% （86/1 092）, χ2=1.162; both P〉0.05]. Conclusions ISUA does not increase emergency cesarean delivery rates for the fetal reasons, but the fetal growth and development may fall behind those with a three-vessel umbilical cord. Monitoring during pregnancy and delivery should be intensified for fetuses with ISUA.