脐带绕颈胎儿脐动脉血流参数与围生儿预后的相关性

Correlation between umbilical artery blood flow parameters and perinatal prognosis in fetuses with umbilical cord around the neck

目的探讨脐带绕颈胎儿脐动脉血流动力学指标参数与围生儿预后的相关性。方法选取2019年7月—2020年6月在临海市第二人民医院孕检的150例孕晚孕妇为研究对象,所有胎儿均伴有脐带绕颈,采用彩色多普勒超声检查所有入组孕妇胎儿的脐动脉血流动力学情况,分析脐动脉血流参数与围生儿预后的相关性。结果两组胎儿脐带绕颈周数和脐带绕颈类型比较,差异均有统计学意义(均P<0.05)。收缩期最大速度/舒张期最小速度(S/D)≥3的脐带绕颈胎儿剖宫产率、胎儿窘迫发生率、胎心异常率、新生儿窒息率及羊水异常率(81.25%、46.88%、37.50%、15.63%及100.00%)均明显高于S/D<3的胎儿(30.51%、7.63%、5.93%、0.85%及15.25%),差异均有统计学意义(χ^(2)=26.729、28.852、22.677、14.316及81.356,均P<0.05)。S/D≥3的脐带绕颈胎儿出生后1 min Apgar评分[(5.29±2.14)分]明显低于S/D<3的胎儿[(9.34±1.18)分],差异有统计学意义(t=14.158,P<0.05);缺氧胎儿脐动脉的搏动指数(PI)、阻力指数(RI)及S/D值[(1.84±0.62)、(0.81±0.18)及(3.14±0.31)]均明显高于未缺氧组胎儿[(1.16±0.41)、(0.56±0.11)及(2.16±0.28)],差异均有统计学意义(t=8.019、10.521及24.862,均P<0.05)。结论脐带绕颈胎儿的脐动脉血流动力学指标能够有效反映胎儿体内血流动力学改变情况,反映胎儿是否出现缺氧、缺血,与围生儿预后状况密切相关。

Objective To investigate the correlation between felal umbilical artery hemodynamic parameters and perinatal prognosis in fetuses with umbilical cord around the neck.Methods A total of 150 late pregnant women who were examined at the Second People's Hospital of Linhai City from July 2019 to June 2020 were selected as the study subjects.All fetuses were accompanied by umbilical cord around the neck.Color Doppler ultrasound was used to examine the umbilical artery hemodynamics of all enrolled pregnant women's fetuses,and the correlation between umbilical artery blood flow parameters and perinatal prognosis was analyzed.Results There were statistically significant differences between the two groups in the number and type of umbilical cord around the neck(both P<0.05).The rates of cesarean section,fetal distress,fetal heart abnormalities,neonatal asphyxia,and amniotic fluid abnormalities(81.25%,46.88%,37.50%,15.63%,and 100.00%)in fetuses with systolic maximum velocity/diastolic minimum velocity(S/D)≥3 were significantly higher than those in fetuses with S/D<3(30.51%,7.63%,5.93%,0.85%,and 15.25%),with significant differences(X=26.729,28.852,22.677)14.316,and 81.356,all P<0.05).The Apgar score(5.29±2.14)score]of fetuses with S/D≥3 around the neck at 1 minute after birth was significantly lower than that of fetuses with S/D<3[(9.34±1.18)score],with a statistically significant difference(t=14.158,P<0.05);The pulsation index(PI),resistance index(RI),and S/D values of the umbilical artery of hypoxic fetuses[(1.84±0.62),(0.81±0.18),and(3.14±0.31)J were significantly higher than those of the non hypoxic fetuses[(1.16±0.41),(0.56±0.11),and(2.16±0.28)],with significant differences(t=8.019,10.521,and 24.862,all P<0.05).Conclusion The umbilical artery hemodynamic indexes of fetuses with umbilical cord around the neck can effectively reflect the hemodynamic changes in the fetus,reflect whether the fetus has hypoxia and ischemia,and are closely related to the prognosis of the perinatal fetus.