脐动脉彩色多普勒血流速度测定、无应激试验及超声检查联合应用在监测脐带缠绕中的预测价值

[Predictive value of combined application of umbilical artery color Doppler velocimetry, nonstress testing and ultrasonography in monitoring umbilical cord entanglement].

作者信息

Zhao S, Dai H, Shao D

机构信息

Department of Gynecology and Obstetrics, Affiliated Hospital of Medical College of Qingdao University, Qingdao 266003, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2001 Apr 25;81(8):468-71.

PMID:11798920

Abstract

OBJECTIVE

To explore the predictive value of combined application of umbilical artery color Doppler flow monitoring (CDFI), nonstress testing (NST) and ultrasonography in monitoring umbilical cord entanglement.

METHODS

1 860 cases of pregnant women between gestational ages of 37 approximately 42 weeks were studied 1 approximately 2 weeks before delivery by CDFI, nonstress testing (NST) and ultrasonography to monitor umbilical cord entanglement.

RESULTS

The prevalence rate of umbilical cord entanglement was 23.23% (432/1 860). Positive predictive value and negative predictive value were 95.4 % (412/432) and 98.6% (1 408/1 428) respectively. The rate of accuracy was 97.8% (1 820/1 860). The rate of fetal distress among the fetuses with umbilical cord round the body or four limbs was 85.29% (23/34) and the incidence of cesarean section in this group was 88.28% (30/34). The rate of fetal distress among the fetuses with umbilical cord round the neck was 13.06% (52/398) and the incidence of cesarean section in this group was 44.94% (178/398). The rates of fetal distress and cesarean section were significantly higher in the group with umbilical cord around the body or four limbs than in the group with umbilical cord around the neck (chi(2) = 107.27 and 23.76 respectively, P < 0.001). The systolic/diastolic (S/D) ratio was basically in normal ranges in the group with the umbilical cord round the neck. In cardiotopography (CTG), umbilical cord entanglement mainly showed variable deceleration (VD), early deceleration (ED), nonreaction on NST, and late deceleration (LD) on oxytocin challenge test (OCT). Prolonged fetal heart rate deceleration (PD) could be seen in the group with umbilical cord around the body or four limbs.

CONCLUSION

The combined application of umbilical artery color Doppler velocimetry, nonstress testing and ultrasonography have an important auxiliary value in monitoring umbilical cord entanglement. It remarkably increases the positive predictive rate as a valuable reference for the choice of delivery form.

摘要

目的

探讨脐动脉彩色多普勒血流监测（CDFI）、无应激试验（NST）及超声检查联合应用在监测脐带绕颈中的预测价值。

方法

对1860例孕37～42周的孕妇在分娩前1～2周采用CDFI、无应激试验（NST）及超声检查监测脐带绕颈情况。

结果

脐带绕颈发生率为23.23%（432/1860）。阳性预测值和阴性预测值分别为95.4%（412/432）和98.6%（1408/1428）。准确率为97.8%（1820/1860）。脐带绕躯干或四肢组胎儿窘迫发生率为85.29%（23/34），该组剖宫产率为88.28%（30/34）。脐带绕颈组胎儿窘迫发生率为13.06%（52/398），该组剖宫产率为44.94%（178/398）。脐带绕躯干或四肢组胎儿窘迫及剖宫产率显著高于脐带绕颈组（χ²分别为107.27和23.76，P<0.001）。脐带绕颈组收缩期/舒张期（S/D）比值基本在正常范围。在胎心监护（CTG）中，脐带绕颈主要表现为变异减速（VD）、早期减速（ED）、NST无反应型以及缩宫素激惹试验（OCT）出现晚期减速（LD）。脐带绕躯干或四肢组可见胎心延长减速（PD）。