Kinugasa Masato, Sato Tetsuya, Tamura Maki, Suzuki Hiromi, Miyazaki Yoshihiko, Imanaka Motoharu
Amagasaki Medical Cooperative Hospital, Department of Obstetrics and Gynecology, Amagasaki, Japan.
J Obstet Gynaecol Res. 2007 Oct;33(5):612-8. doi: 10.1111/j.1447-0756.2007.00620.x.
We evaluated the efficacy of antepartum screening for cord presentation by trans-vaginal ultrasonography (TVS) on predicting and preventing umbilical cord prolapse (UCP) in term breech delivery.
We investigated every woman with a breech-presenting fetus for cord presentation by weekly TVS after 36 weeks of gestation since 1995. If the cord was found in advance of fetal presenting parts, we recommended her to undergo elective cesarean section to avoid UCP. We studied the incidence of cord presentation by TVS and the clinical courses of the cases with it for 198 women who delivered breech after 36 weeks from 1995 to 2005 (group A). Further, the incidence of UCP was compared between group A and another 230 women who delivered breech at term from 1983 to 1994 (group B).
Cord presentation was detected by TVS at least once in eight (4%) group A patients. Seven of them underwent elective cesarean section and, in six of these (86%), cord presentation was still found at the time of operation. The eighth patient became free of cord presentation at the later examinations and delivered vaginally without UCP. A hundred and twenty-one (61%) women in group A and 159 (69%) women in group B delivered vaginally. No UCP occurred in group A, while it occurred in 10 (4%) cases of group B (P < 0.01), and one baby died of it.
Detection of cord presentation by TVS has a potential to predict and reduce UCP in breech delivery at term.
我们评估了经阴道超声检查（TVS）进行产前脐带先露筛查对预测和预防足月臀位分娩时脐带脱垂（UCP）的效果。
自1995年起，我们对每一位臀位胎儿的孕妇在妊娠36周后每周进行TVS检查以筛查脐带先露。如果在胎先露之前发现脐带，我们建议她接受选择性剖宫产以避免脐带脱垂。我们研究了1995年至2005年期间36周后分娩臀位的198名妇女（A组）经TVS检查脐带先露的发生率及其临床过程。此外，比较了A组与1983年至1994年期间足月分娩臀位的另外230名妇女（B组）脐带脱垂的发生率。
A组有8名（4%）患者至少一次经TVS检查发现脐带先露。其中7名接受了选择性剖宫产，其中6名（86%）在手术时仍发现有脐带先露。第8名患者在随后的检查中脐带先露消失，经阴道分娩且未发生脐带脱垂。A组121名（61%）妇女和B组159名（69%）妇女经阴道分娩。A组未发生脐带脱垂，而B组有10例（4%）发生脐带脱垂（P<0.01），1名婴儿因此死亡。
经TVS检查发现脐带先露有可能预测并减少足月臀位分娩时的脐带脱垂。
