脐带绕颈的相关因素分析

Analysis of related factors of umbilical cord around neck

目的探讨脐带绕颈的相关因素及其对脐动脉血流参数(S/D、RI)、产程、分娩方式及围产儿预后的影响。方法收集在本院完成产前超声检查并住院分娩单活胎的2 109名孕妇资料,分为绕颈组与无绕颈组。采用单因素和多因素Logistic回归模型对11种因素进行筛选;分析脐带绕颈对脐动脉血流参数、产程、分娩方式及围产儿预后的影响。分析679胎的胎方位、胎盘位置、缠绕方向与形成缠绕角度的关系。结果 270胎(270/679,39.76%)脐带绕颈发生于胎盘附着子宫前壁的胎儿,且以C型(127/270,47.04%)、α型较多(122/270,45.19%)。两组脐动脉血流参数(S/D、RI)、产程、分娩方式及围产儿预后差异无统计学意义。单因素分析发现孕妇年龄、新生儿性别和脐带长度与脐带绕颈相关。多因素分析结果表明脐带越长,绕颈发生率越高;新生儿性别与脐带绕颈相关。结论脐带长度是脐带绕颈的主要危险因素。脐带绕颈的角度由胎方位、胎盘位置及缠绕方向3者决定。脐带绕颈对脐动脉血流参数(S/D、RI)、产程、分娩方式及围产儿预后无影响。

Objective To investigate the related factors of nuchal umbilical cord,and the impact on umbilical artery blood flow parameters（S/D,RI）,stage of labor,delivery methods and perinatal prognosis.Methods Totally 2 109 pregnant women who completed prenatal ultrasound exminnation in the hospital and hospitalized childbirth with single fetus were collected.All subjects divided into nuchal cord group and no nuchal cord group.Eleven factors in one-way and multivariable Logistic analysis were performed.The impact of umbilical cord around the neck on umbilical artery blood flow parameters,stage of labor,delivery methods and the effects of perinatal prognosis were analyzed.The relationship between fetal position,placental position,winding directions and winding angle were evaluated.Results Totally 270fetuses（270/679,39.76%）of nuchal cord was found with anterior wall of the placental attachment of uterus and most of them were C type（127/270,47.04%）andαtype（122/270,45.19%）.It was no statistical difference of umbilical artery blood flow parameters（S/D,RI）,stage of labor,delivery methods and perinatal prognosis in both groups.Age of pregnant women,the fetal sex and cord length of the newborn had the significant effects on the cord around neck with one-way analysis;multivariate analysis showed that the longer the umbilical cord,the higher the incidence of umbilical cord around the neck,the neonatal sex associates with umbilical cord around the neck.Conclusion The cord length is the major factor affecting the cord.Umbilical cord around the neck has no impact on umbilical artery blood flow parameters（S/Dm,RI）,stage of labor,delivery methods and perinatal prognosis.