Romero Gutiérrez G, Estrada Razo S, Chávez Curiel A, Ponce Ponce de León A L
Hospital de Ginecopediatría N. 48, Instituto Mexicano del Seguro Social, Unidad de Investigación en Epidemiología Clínica, León, Guanajuato.
Ginecol Obstet Mex. 2000 Oct;68:401-7.
In order to evaluate the presence of nuchal cord entanglement and to measure resistance index with Doppler color ultrasonography, a prospective, observational, cross-sectional study was carried out, 132 low risk term pregnant women were included, 50 of them had umbilical cord encirclement (37%), the sensitivity, specificity, positive predictive and negative predictive values were 92%, 87%, 81% and 95%, respectively. McNemar'test for discordance had a p = 0.121 in comparing ultrasonography result with the gold standard. Patients with nuchal cord entanglement had higher frequency of cesarean section (70%, p < 0.05) than those without it. On the other hand, normal vaginal delivery was more common (46%, p < 0.05) in patients without nuchal coiling of the umbilical cord. There were no significant difference in evaluating acute fetal distress, meconium stained amniotic fluid, newborn Apgar scores at one and five minutes, birth weight, neonatal intensive care unit admissions and intrapartum stillbirths. In our patients with nuchal cord entanglement the resistance index average values were 0.59 and those without nuchal cord were 0.60 (p = 0.712). We concluded that color flow Doppler ultrasonography is a reliable tool to detect nuchal coiling of the umbilical cord, and therefore Doppler color waveforms assessment in nuchal cord entanglements might helpful for clinicians to decide a closer surveillance in labor by using intrapartum cardiotocography.
为了通过彩色多普勒超声评估脐带绕颈的情况并测量阻力指数,我们开展了一项前瞻性、观察性横断面研究,纳入了132例低风险足月孕妇,其中50例有脐带绕颈(37%),其灵敏度、特异度、阳性预测值和阴性预测值分别为92%、87%、81%和95%。将超声检查结果与金标准进行比较时,不一致性的McNemar检验p = 0.121。有脐带绕颈的患者剖宫产频率(70%,p < 0.05)高于无脐带绕颈的患者。另一方面,无脐带绕颈的患者正常阴道分娩更为常见(46%,p < 0.05)。在评估急性胎儿窘迫、羊水粪染、新生儿1分钟和5分钟阿氏评分、出生体重、新生儿重症监护病房收治情况及产时死产方面,差异无统计学意义。在我们有脐带绕颈的患者中,阻力指数平均值为0.59,无脐带绕颈的患者为0.60(p = 0.712)。我们得出结论,彩色多普勒超声是检测脐带绕颈的可靠工具,因此对脐带绕颈进行多普勒彩色波形评估可能有助于临床医生通过产时胎心监护决定在分娩时进行更密切的监测。