单胎脐带过度扭转产时胎心监护特征及围产结局

Fetal heart monitoring characteristics and perinatal outcome of a single fetus with excessive umbilical cord torsion

目的 探讨脐带过度扭转的产妇在产时胎心监护图形特点、分娩方式及对围产儿预后的影响。方法 本研究采用回顾性病例对照研究的方法,选取2012年1月—2021年12月于北京某三甲医院产科住院分娩时发现脐带过度扭转的单胎孕妇122例(扭转组),同期住院的无脐带过度扭转136例产妇(对照组),比较两组产妇的一般情况、分娩方式、围产儿结局,及不同程度脐带过度扭转的胎心监护特征对新生儿的影响。结果 扭转组与对照组间产妇的平均孕周差异有统计学意义(P<0.05),在分娩方式(剖宫产或阴道顺产)、新生儿出生体重、身长、脐带长度、胎儿窘迫发生率差异有统计学意义(P<0.05),扭转组的Ⅱ类、Ⅲ类胎心监护图形显著高于对照组(P<0.05),脐带重度扭转与轻度扭转相比,更易发生胎儿窘迫、出现Ⅱ类、Ⅲ类监护,差异均有统计学意义(P<0.05)。结论 脐带过度扭转存在一定的孕期高危因素,增加了剖宫产和阴道助产的机会,胎儿宫内窘迫发生率增加,其大部分监护图形正常,但Ⅱ类,Ⅲ类图形明显增加。

Objective To explore the influence of fetal heart monitoring pattern,delivery mode and perinatal prognosis in women with excessive umbilical cord torsion.Methods A retrospective case-control study was used in this study.The observation group was used to select a total of 122 women with a single fetus during delivery in a third class Hospital Obstetrics Department from January 2012 to December 2021 with excessive umbilical cord torsion.In the same period,136 of the puerperae without excessive torsion of the umbilical cord were selected as the control group.The general condition,mode of delivery,perinatal outcomes,and the influences of fetal heart monitoring characteristics with different umbilical coiling index on fetal and neonatal outcomes were retrospectively analyzed between two groups.Results Compared with the control group,there was statistically significant differences in mean gestational age in the observation group(P<0.05).Also statistically significant differences in delivery mode(cesarean section or natural delivery),newborn birth weight,body length,umbilical cord length and fetal distress incidence rate(P<0.05).The typeⅡand typeⅢfetal heart monitoring in the observation group were significantly higher than that in the control group(P<0.05).Compared with the UCL-H and UCL-L,there were statistical significance in fetal distress,typeⅡmonitoring and typeⅢmonitoring(P<0.05)Conclusion Excessive torsion of umbilical cord have certain risk factors during pregnancy,which increase the chance of cesarean section and vaginal midwifery,and increase the incidence of fetal distress.In fetal heart monitoring,the patterns of typeⅡand tpyeⅢare significantly increased.