Airas Urpu, Heinonen Seppo
Department of Obstetrics and Gynecology, Kuopio University Hospital, Finland.
Am J Perinatol. 2002 Apr;19(3):127-32. doi: 10.1055/s-2002-25311.
The objective of this study is to determine the risk of adverse pregnancy outcomes resulting from a true umbilical knot. We analyzed 288 singleton pregnancies with a true umbilical knot among the women who gave birth at Kuopio University Hospital from January 1990 to December 1999. Logistic regression analysis was used to compare pregnancy outcomes of the affected cases with those of the general obstetric population (n = 23,027). The incidence of true knot was 1.25% and it was associated with advanced maternal age, multiparity, previous miscarriages, obesity, prolonged gravidity, male fetus, long cord, and maternal anemia. The women having a fetus with a cord knot underwent cesarean delivery less frequently than unaffected controls. Fetal death and low Apgar score at 1 min occurred significantly more frequently in the study group than in the general obstetric population, the adjusted odds ratios being 3.93 (95% CI, 1.41-11.0) and 1.73 (95% CI, 1.10-2.72), respectively. Otherwise, the pregnancy outcome measures were comparable in the two groups. Fetuses with true umbilical knots are at a four-fold increased risk of stillbirth, but little can be done to prevent fetal deaths during pregnancy. Surviving fetuses with true knots are likely to suffer temporary distress during delivery, but affected newborns recover soon after birth. Thus, monitored vaginal delivery appears to be a safe option for fetuses with true knots.
本研究的目的是确定真性脐带打结导致不良妊娠结局的风险。我们分析了1990年1月至1999年12月在库奥皮奥大学医院分娩的288例单胎妊娠合并真性脐带打结的病例。采用逻辑回归分析比较受影响病例与普通产科人群（n = 23,027）的妊娠结局。真性脐带打结的发生率为1.25%，与产妇年龄较大、多产、既往流产、肥胖、孕期延长、男性胎儿、脐带过长和产妇贫血有关。有脐带打结胎儿的妇女剖宫产的频率低于未受影响的对照组。研究组胎儿死亡和1分钟时阿氏评分低的发生率显著高于普通产科人群，调整后的优势比分别为3.93（95%CI，1.41 - 11.0）和1.73（95%CI，1.10 - 2.72）。否则，两组的妊娠结局指标具有可比性。真性脐带打结的胎儿死产风险增加四倍，但孕期几乎无法预防胎儿死亡。存活的有真性脐带打结的胎儿在分娩期间可能会遭受短暂窘迫，但受影响的新生儿出生后很快恢复。因此，对于有真性脐带打结的胎儿，监测下阴道分娩似乎是一种安全的选择。
