新生儿脐带绕颈4周及以上的临床分析  

Clinical Analysis of Neonates with Umbilical Cord Wrapped Around the Neck for 4 or More Loops

作　　者：吴茜子 艾国 余楠 杨宜红 周琴[1] WU Xizi;AI Guo;YU Nan(Department of Obstetrics and Gynecology,Tongji Medical College,Huazhong University of Science and Technology,Wuhan Hubei 430030,China;Department of Pediatrics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan Hubei 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院妇产科,湖北武汉430030 [2]华中科技大学同济医学院附属同济医院儿科,湖北武汉430030

出　　处：《实用妇产科杂志》2024年第9期723-728,共6页Journal of Practical Obstetrics and Gynecology

基　　金：国家自然科学基金(编号:81701530)。

摘　　要：目的:探讨新生儿脐带绕颈≥4周的高危因素、超声检查诊断符合率及妊娠结局。方法:选取2011年1月至2024年2月于华中科技大学同济医学院附属同济医院分娩的新生儿脐带绕颈≥4周的64例孕妇(脐带绕颈≥4周组)的临床资料进行回顾性分析,同时随机选取同一时期分娩的新生儿脐带绕颈1~2周的80例孕妇(脐带绕颈1~2周组)作为对照。收集两组一般资料、临床表现、超声诊断等资料,采用单因素及多因素Logistic回归分析脐带绕颈≥4周的高危因素、超声检查诊断符合率,并比较两组胎儿结局的差异。结果:①脐带绕颈≥4周组孕次、人工流产次数、产次、剖宫产史次数比脐带绕颈1~2周组低,自觉胎动异常、脐动脉收缩末期峰值与舒张末期峰值比(S/D)异常、胎心监护(NST)异常、胎儿窘迫的发生率比脐带绕颈1~2周组高,差异均有统计学意义(P<0.05)。②多因素Logistic回归分析示:羊水过多及脐带过长是脐带绕颈≥4周的独立危险因素(OR>1,P<0.05)。③超声检查诊断脐带绕颈≥4周在距剖宫产术前时间≤2 d时,超声诊断的符合率最高,与>3 d的符合率差异有统计学意义(46.2%vs.6.3%,P<0.05);与脐带绕颈≤3周比较,超声诊断脐带绕颈4周和5周的超声诊断符合率更高,差异有统计学意义(P<0.05)。④脐带绕颈≥4周组早产、新生儿窒息、入住新生儿科的发生率高于脐带绕颈1~2周组,差异有统计学意义(P<0.05);胎儿分娩孕周及新生儿出生体质量小于脐带绕颈1~2周组,差异有统计学意义(P<0.05)。结论:羊水过多及脐带过长是脐带绕颈≥4周的高危因素。超声诊断距剖宫产术前时间越近以及脐带绕颈周数越多,诊断符合率越高。脐带绕颈≥4周的新生儿结局更差。Objective:To investigate the high risk factors,diagnostic accuracy of ultrasonography and pregnancy outcomes of umbilical cord wrapped around the neck for≥4 loops.Methods:The clinical data of 64 pregnant women with umbilical cord around the neck for≥4 loops(the group with umbilical cord around the neck≥4 loops)in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2011 to February 2024 were retrospectively analyzed.At the same time,80 cases with umbilical cord around the neck for 1-2 loops(the group with umbilical cord ar ound the neck 1-2 loops)were randomly selected as the controls.General information,clinical manifestations,ultrasound diagnosis and other data of the two groups were collected.The risk factors of umbilical cord around the neck≥4 loops and diagnostic accuracy of ultrasonography were analyzed with univariate and multivariate Logistic regression analysis,and the pregnancy outcomes were compared between the two groups.Results:①The incidence of pregnancy,abortion,delivery and history of cesarean section were lower in the group with umbilical cord around the neck≥4 loops than those in the group with umbilical cord around the neck 1-2 loops.The incidence of consciously abnormal fetal movement,abnormal umbilical artery systolic/diastolic(S/D)ratio,abnormal fetal heart rate monitoring(NST)and fetal distress were higher in the group with umbilical cord around the neck≥4 loops than those in the group with umbilical cord around the neck 1-2 loops,and the differences were statistically significant(P<0.05).②Multivariate Logistic regression analysis showed that polyhydramnios and excessively long cord were independent risk factors for umbilical cord around the neck≥4 loops(OR>1,P<0.05).③When the time between ultrasound diagnosis and the operation was≤2 days,the consistency rate between ultrasound diagnosis of umbilical cord around the neck≥4 loops and intraoperative diagnosis was the highest,and the difference was statistically significant w

关 键 词：脐带绕颈 4周 超声诊断 高危因素 妊娠结局 

分 类 号：R714.1[医药卫生—妇产科学]