Hashimoto Kazumasa, Clapp James F
Department of Reproductive Biology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA.
J Soc Gynecol Investig. 2003 Oct;10(7):406-11. doi: 10.1016/s1071-5576(03)00139-4.
We investigated the effect of a nuchal cord on fetal hypoxia by using amniotic fluid and cord blood erythropoietin as markers of chronic and acute hypoxia, respectively.
A total of 167 full-term pregnancies without maternal complications or fetal prelabor complications except fetal growth restriction of unknown cause were studied prospectively. Of these, 47 had a nuchal cord at delivery, and 62 had one or more complications during labor and delivery (nonreassuring fetal heart rate pattern, birth weight less than 2500 g, Apgar score at 1 minute less than 7, presence of meconium-stained amniotic fluid, oligohydramnios), and 26 had both nuchal cord and at least one of the intrapartum complications.
Erythropoietin levels (mean +/- standard error of the mean) were not significantly different between the nuchal cord group (n = 47) and the no nuchal cord group (n = 120) in either amniotic fluid (19.3 +/- 4.1 mU/mL versus 13.7 +/- 1.1 mU/mL) or cord blood (57.9 +/- 10.3 mU/mL versus 52.1 +/- 4.9 mU/mL). Similarly, in the 62 fetuses with intrapartum complications, there were no significant differences in amniotic fluid (14.3 +/- 2.0 mU/mL versus 18.8 +/- 2.9 mU/mL) or cord blood erythropoietin (66.9 +/- 16.8 mU/mL versus 72.6 +/- 12.6 mU/mL) levels between those with (n = 26) or without a nuchal cord (n = 36). Among the 107 uncomplicated cases, however, amniotic fluid erythropoietin was significantly elevated in the nuchal cord group (25.5 +/- 8.7 mU/mL, n = 21) compared with that in the no nuchal cord group (11.5 +/- 0.9 mU/mL, n = 84) (P <.05), whereas there was no significant between-group difference in cord blood erythropoietin levels between nuchal cord and no nuchal cord groups (46.8 +/- 10.0 mU/mL versus 43.3 +/- 4.1 mU/mL). Tightness of the nuchal cord did not affect amniotic fluid or cord blood erythropoietin concentrations.
Although nuchal cord may not significantly increase the risk of acute or labor-associated fetal hypoxia, it appears to be an independent risk factor of mild, chronic, prelabor fetal hypoxia.
我们分别以羊水和脐血促红细胞生成素作为慢性和急性缺氧的标志物，研究脐带绕颈对胎儿缺氧的影响。
前瞻性研究了总共167例足月妊娠，这些妊娠无母体并发症或胎儿产前并发症，除非存在原因不明的胎儿生长受限。其中，47例在分娩时存在脐带绕颈，62例在分娩过程中出现一种或多种并发症（胎儿心率异常、出生体重低于2500g、1分钟阿氏评分低于7分、羊水粪染、羊水过少），26例既存在脐带绕颈又有至少一种产时并发症。
脐带绕颈组（n = 47）和无脐带绕颈组（n = 120）的羊水促红细胞生成素水平（均值±均值标准误）无显著差异（19.3±4.1 mU/mL对13.7±1.1 mU/mL），脐血促红细胞生成素水平也无显著差异（57.9±10.3 mU/mL对52.1±4.9 mU/mL）。同样，在62例有产时并发症的胎儿中，有脐带绕颈（n = 26）和无脐带绕颈（n = 36）的胎儿羊水促红细胞生成素水平（14.3±2.0 mU/mL对18.8±2.9 mU/mL）及脐血促红细胞生成素水平（66.9±16.8 mU/mL对72.6±12.6 mU/mL）均无显著差异。然而，在107例无并发症的病例中，脐带绕颈组的羊水促红细胞生成素水平（25.5±8.7 mU/mL，n = 21）显著高于无脐带绕颈组（11.5±0.9 mU/mL，n = 84）（P <.05），而脐带绕颈组和无脐带绕颈组的脐血促红细胞生成素水平无显著组间差异（46.8±10.0 mU/mL对43.3±4.1 mU/mL）。脐带绕颈紧度不影响羊水或脐血促红细胞生成素浓度。
虽然脐带绕颈可能不会显著增加急性或分娩相关胎儿缺氧的风险，但它似乎是轻度、慢性、产前胎儿缺氧的一个独立危险因素。
