单脐动脉是否为围生儿死亡的独立危险因素？
Is single umbilical artery an independent risk factor for perinatal mortality?
机构信息
Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel.
出版信息
Arch Gynecol Obstet. 2011 Feb;283(2):191-4. doi: 10.1007/s00404-009-1326-3. Epub 2009 Dec 19.
OBJECTIVE
To evaluate perinatal outcome of fetuses with isolated single umbilical artery (SUA), and specifically to examine whether an isolated SUA is an independent risk factor for perinatal mortality.
METHODS
A population-based study was conducted, comparing pregnancies of women with and without SUA. Deliveries occurred between the years 1988-2006, in a tertiary medical center. Multiple gestations, chromosomal abnormalities and malformations were excluded from the analysis. Stratified analysis was performed using multiple logistic regression models to evaluate the association between SUA and perinatal mortality, while controlling for confounders.
RESULTS
Out of 194,809 deliveries, 243 (0.1%) were of fetuses with isolated SUA. Fetuses with SUA were smaller (2,844 ± 733 vs. 3,197 ± 530 g, P < 0.001), and were delivered at an earlier gestational age (38.3 ± 3.0 vs. 39.3 ± 2.1 weeks, P < 0.001), when compared with fetuses with normal umbilical vessels. Mothers to fetuses with isolated SUA tended to have a history of infertility treatments (4.5 vs. 1.7%; P = 0.001) when compared with the comparison group. Fetuses with SUA had more complications, including fetal growth restriction (FGR 9.5 vs. 1.9%, P < 0.001), polyhydramnios (11.5 vs. 3.7%; P < 0.001) and oligohydramnios (6.6 vs. 2.2%; P < 0.001). Deliveries of SUA fetuses had higher rates of placental abruption (3.3 vs. 0.7%; P < 0.001), placenta previa (1.2 vs. 0.4%; P = 0.03) and cord prolapse (2.9 vs. 0.4%; P < 0.001). Higher rates of cesarean deliveries were noted in this group (23.9 vs. 12.2%; P < 0.001). SUA newborns had higher rates of low Apgar scores (<7) in one (11.8 vs. 3.7%; P < 0.001) and 5 min (3.5 vs. 0.4%; P < 0.001). Higher rates of perinatal mortality were noted in the SUA group, as compared to fetuses with normal umbilical vessels (6.6 vs. 0.9%, OR 7.78; 95% CI 4.7-13.0; P < 0.001). Using a multiple logistic regression model, controlling for possible confounders, such as FGR, oligohydramnios, polyhydramnios, prolapse of cord, maternal hypertension and diabetes mellitus, isolated SUA remained an independent risk factor for perinatal mortality (adjusted OR = 3.91, 95% CI 2.06-7.43; P < 0.001).
CONCLUSION
Isolated SUA in our population was noted as an independent risk factor for perinatal mortality.
目的
评估单纯性单脐动脉（SUA）胎儿的围产结局，特别是检查孤立性 SUA 是否是围产儿死亡的独立危险因素。
方法
本研究为基于人群的研究，比较了伴有和不伴有 SUA 的孕妇的妊娠情况。在一家三级医疗中心进行了 1988 年至 2006 年期间的分娩。将多胎妊娠、染色体异常和畸形排除在分析之外。使用多变量逻辑回归模型进行分层分析，以评估 SUA 与围产儿死亡率之间的关联，同时控制混杂因素。
结果
在 194809 例分娩中，有 243 例（0.1%）胎儿为单纯性 SUA。SUA 胎儿较小（2844±733 与 3197±530 g，P<0.001），且在较早的胎龄（38.3±3.0 与 39.3±2.1 周，P<0.001）分娩。与具有正常脐血管的胎儿相比。与对照组相比，孤立性 SUA 胎儿的母亲更倾向于有不孕治疗史（4.5%与 1.7%；P=0.001）。SUA 胎儿有更多的并发症，包括胎儿生长受限（FGR 9.5%与 1.9%，P<0.001）、羊水过多（11.5%与 3.7%；P<0.001）和羊水过少（6.6%与 2.2%；P<0.001）。SUA 胎儿的胎盘早剥（3.3%与 0.7%；P<0.001）、前置胎盘（1.2%与 0.4%；P=0.03）和脐带脱垂（2.9%与 0.4%；P<0.001）发生率更高。该组剖宫产率更高（23.9%与 12.2%；P<0.001）。SUA 新生儿在 1 分钟（11.8%与 3.7%；P<0.001）和 5 分钟（3.5%与 0.4%；P<0.001）时 Apgar 评分较低的发生率更高。与具有正常脐血管的胎儿相比，SUA 组围产儿死亡率更高（6.6%与 0.9%，OR 7.78；95%CI 4.7-13.0；P<0.001）。使用多变量逻辑回归模型，控制可能的混杂因素，如 FGR、羊水过少、羊水过多、脐带脱垂、母体高血压和糖尿病，孤立性 SUA 仍然是围产儿死亡的独立危险因素（调整 OR=3.91，95%CI 2.06-7.43；P<0.001）。
结论
本研究人群中孤立性 SUA 被认为是围产儿死亡的独立危险因素。
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