脐带过度扭转新生儿结局

Effect of excessive umbilical cord torsion on fetal and neonatal outcomes

目的探讨脐带过度扭转对胎儿及新生儿的影响。方法选择2016年7月至2020年6月在北京妇产医院分娩的脐带过度扭转产妇为观察组,按1∶1的比例选取同期无脐带过度扭转的产妇为对照组,回顾性分析两组产妇的一般情况、分娩方式、围产儿结局,以及脐带过度扭转产妇不同脐带螺旋指数(umbilical coiling index,UCI)[脐带扭转周数/脐带长度(cm)]对新生儿的影响。结果观察组(1780例)分娩新生儿胎龄、出生体重、身长均小于对照组[(37.9±3.2)周比(38.4±2.9)周,(3007±726)g比(3354±616)g,(48.5±4.3)cm比(49.6±4.1)cm],胎儿宫内窘迫、新生儿窒息、脐血pH<7.20发生率均高于对照组[34.9%(622/1780)比12.9%(230/1780),1.5%(26/1780)比0.7%(13/1780),4.2%(75/1780)比2.8%(49/1780)],差异有统计学意义(P<0.05)。UCI≥0.73组新生儿胎龄、出生体重、身长低于UCI<0.73组,脐血pH<7.20及新生儿窒息发生率高于UCI<0.73组,差异均有统计学意义(P<0.05)。结论脐带过度扭转增加了胎儿缺氧及新生儿窒息风险,对新生儿胎龄、出生体重及身长均有明显影响,UCI越大,对新生儿影响越大。

Objective To study the effect of excessive torsion of the umbilical cord on fetal or neonatal outcomes.Methods The observation group was selected from the puerperae who delivered in Beijing Obstetrics and Gynecology Hospital from July 2016 to June 2020 with excessive torsion of the umbilical cord.In the same period,the puerperae without excessive torsion of the umbilical cord were selected as the control group with a ratio of 1∶1.The general condition,mode of delivery,perinatal outcomes,and the effect of different umbilical coiling index(UCI)[twisted umbilical cord weeks/umbilical cord length(cm)]on fetal and neonatal outcomes were retrospectively analyzed between two groups.Results Compared with the control group,the observation group(1780 cases)had smaller neonatal gestational age[(37.9±3.2)weeks vs.(38.4±2.9)weeks],birth weight[(3007±726)g vs.(3354±616)g]and length[(48.5±4.3)cm vs.(49.6±4.1)cm],but higher incidence of fetal distress[34.9%(622/1780)vs.12.9%(230/1780)],neonatal asphyxia[1.5%(26/1780)vs.0.7%(13/1780)],and cord blood pH<7.20[4.2%(75/1780)vs.2.8%(49/1780)],the difference was statistically significant(P<0.05).The UCI≥0.73 group had lower neonatal gestational age,birth weight and length,but higher incidence of cord blood pH<7.20 and neonatal asphyxia than the UCI<0.73 group,with statistically significant differences(P<0.05).Conclusions Excessive torsion of the umbilical cord increases the incidence of fetal hypoxia and neonatal asphyxia and has a significant effect on neonatal gestational age,birth weight and length.The higher the UCI,the greater the impact on fetus and neonate.