Miser W F
Family Practice Service, Reynolds Army Community Hospital, Fort Sill, OK.
J Fam Pract. 1992 Apr;34(4):441-5.
The effect of a nuchal cord on the outcome of delivery is controversial. The purposes of this study were to investigate the frequency of nuchal cords and determine the effect that nuchal cords have on the neonate.
In a retrospective, case-control study, 706 consecutive infant deliveries in a community hospital were evaluated. Sixteen deliveries that were complicated by the umbilical cord entangled around an extremity or by a prolapsed cord were excluded from further analysis. The study group consisted of the 167 deliveries (23.7%) complicated by a nuchal cord. The remaining 523 deliveries were used as the control group.
There were no significant differences found in maternal age, race, parity, prepregnancy weight, or amount of weight gain between the mothers of the infants in the two groups. Fetal bradycardia and variable decelerations in fetal heart rate occurred almost twice as often in the nuchal cord group (18.6% as compared with 9.6%, P less than .01). Despite this finding, there was no significant difference in the number of operative deliveries or in Apgar scores at 1 and 5 minutes between the two groups. There were no perinatal deaths associated with nuchal cords. Infants born with nuchal cords weighed less than those in the control group (3345 g compared with 3468 g, P less than .01). There were also significantly fewer large-for-gestational-age and macrosomic infants born in the nuchal cord group. Complications such as jaundice, hypoglycemia, sepsis, and respiratory problems were not increased in the postnatal period because of a nuchal cord.
This study suggests that nuchal cords are common and are rarely associated with significant morbidity or mortality in neonates.
脐带绕颈对分娩结局的影响存在争议。本研究的目的是调查脐带绕颈的发生率，并确定脐带绕颈对新生儿的影响。
在一项回顾性病例对照研究中，对一家社区医院连续706例婴儿分娩进行了评估。16例因脐带缠绕肢体或脐带脱垂而复杂的分娩被排除在进一步分析之外。研究组由167例（23.7%）因脐带绕颈而复杂的分娩组成。其余523例分娩用作对照组。
两组婴儿母亲的年龄、种族、产次、孕前体重或体重增加量之间没有显著差异。脐带绕颈组胎儿心动过缓和胎儿心率变异减速的发生率几乎是对照组的两倍（分别为18.6%和9.6%，P<0.01）。尽管有这一发现，但两组之间的手术分娩数量或1分钟和5分钟时的阿氏评分没有显著差异。没有与脐带绕颈相关的围产期死亡。脐带绕颈出生的婴儿体重低于对照组（分别为3345克和3468克，P<0.01）。脐带绕颈组出生的大于胎龄儿和巨大儿也明显较少。由于脐带绕颈，出生后黄疸、低血糖、败血症和呼吸问题等并发症并没有增加。
本研究表明脐带绕颈很常见，很少与新生儿显著的发病率或死亡率相关。
