脐带绕颈多圈160例临床回顾性研究

A clinical retrospective study on 160 cases of multiple umbilical cord around the neck

目的对脐带绕颈多圈（≥3圈）与脐带绕颈1～2圈患者母胎结局进行比较。方法回顾分析2014年1月至2017年4月浙江大学医学院附属妇产科医院37～42周出生的160例脐带绕颈多圈、枕先露分娩患者病例资料，对每例患者随机选择当天出生的2例枕先露分娩、脐带绕颈1～2圈病例作为对照组。比较两组母胎结局。Logistic回归分析寻找脐带绕颈多圈组羊水粪染相关因素。结果（1）脐带绕颈多圈发病率0.45%。（2）组间比较：病例组中胎动异常或监护异常发生率高于对照组[33.13%（53/160）比8.13%（26/320）]，P＝0.000；脐动脉S/D值低于对照组[2.00（0.40）比2.14（0.40）]，P＝0.000；剖宫产率高于对照组[81.25%（130/160）比7.50%（24/320）]，P＝0.000；新生儿出生体质量低于对照组[（3 143±367） g比（3 323±349） g]，P＝0.000。（3）亚组间比较：病例组中阴道分娩者（n＝30）侧切或产钳率高于对照组中阴道分娩者（n＝296）[30.00%（9/30）比12.50%（37/296）]，P＝0.009；新生儿出生1及5 min Apgar评分均低于对照组中阴道分娩者[10（1.25）（分）比10（0）（分），10（0）（分）比10（0）（分）]，P分别为0.000、0.012；而两组羊水粪染率、新生儿出生1 min Apgar评分≤7分率、NICU入住率差异均无统计学意义，均P〉0.05。（4）Logistic回归表明：4个因素与病例组羊水粪染发生相关：孕周≥39周、胎儿体质量〉3 500 g，脐带绕颈≥4圈及阴道试产。结论（1）脐带绕颈多圈临床处理更积极，阴道分娩导致APGAR评分降低，但未增加新生儿窒息发生率。（2）孕周≥39周、胎儿体质量〉3 500 g、脐带绕颈≥4圈、阴道试产是脐带绕颈多圈发生羊水粪染的独立危险因素。

Objective To compare the neonatal and maternal outcomes between the patients with umbilical cord around the neck （ ≥ 3 loops） and with （ 1 or 2 loops）. Methods A retrospective analysis was conducted on the clinical data of 160 cases with multiple umbilical cord around the neck （ ≥3 loops） in the Department of Obstetrics, Women＇s Hospital School of Medicine Zhejiang University between January 2014 and April 2017. For each case, two control women who gave birth at the same day with vertex position and singletons were selected. The neonatal and maternal outcomes were compared. Result （1） The incidence of cord muhiple cord around the neck （ t〉 3 loops） in our hospital was 0.45%. （2） Comparison between groups ： The rate of abnormal fetal movement or abnormal cardiotocography in case group was higher than those of the control group, （33. 13%, 53/160） vs （8. 13%, 26/320）, with significant difference, P = 0. 000. The Umbilical Artery Systolic/diastolic （S/D） ratio of the case group was lower than that of the control group, 2. 00（0. 40） vs 2. 14（0.40） , with significant difference, P = 0. 000. The cesarean section rate of the case group was higher than that of the control group, （81.25% , 130/160） vs （7.50% , 24/ 320）, and the difference was statistically significant, P = 0. 000. Birth Weight of the case group was lower than that of the control group, （3 143 ±367） g vs （3 323±349） g, with significant difference, P =0. 000. （3） Comparison between subgroups：The rate of lateral incision or obstetrical forceps in the subgroup of virginal delivery among the case group （ n = 30 ） was higher than that in the control group （ n = 296 ） , （30. 00% , 9/30） vs （12.50% , 37/296） , with significant difference, P =0. 009. While, the Apgar score at 1 and 5 rain of the virginal delivery ease in the case group were lower than that in the control group, 10 （1.25） vs 10（0） and 10（0） vs 10（0）, there were both significant difference, P =0.000, 0.012,respectively. The rate of meconium-stained amniotic fluid, 1 min Apgar score of 〈 7 and NICU admission were showed no significance, all P 〉 0. 05. （4） After Logistic regression, the four factors most closely associated with meconium-stalned amniotic fluid in patients with multiple cord around the neck （ 〉3 loops）, which were gestational age 〉139 weeks, Birth Weight 〉 3 500 g, umbilical cord around the neck 〉14 loops, and trial of labor. Conclusion （ 1 ） Multiple umbilical cord around the neck （ ≥ 3 loops） had a more positive treatment. Vaginal delivery led to lower APGAR score, but didn＇t increase the incidence of neonatal asphyxia. （2） Independent risk factors for meconium-stained amniotic fluid were gestational age ≥39 weeks, Birth Weight 〉 3 500 g, umbilical cord around the neck 〉4 loops and trial of labor.