单脐动脉的危险因素和妊娠结局。
Single umbilical artery risk factors and pregnancy outcomes.
机构信息
From the Department of Obstetrics and Gynaecology, The Moncton Hospital, Moncton, New Brunswick, Canada; the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada; and the Perinatal Epidemiology Research Unit, Department of Obstetrics and Gynaecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
出版信息
Obstet Gynecol. 2010 Oct;116(4):843-850. doi: 10.1097/AOG.0b013e3181f0bc08.
OBJECTIVE
To identify risk factors for fetuses and neonates with single umbilical artery and isolated single umbilical artery (single umbilical artery in the absence of chromosomal abnormalities and structural abnormalities) and to assess whether there is an increased risk for complications during pregnancy, labor, and delivery, and for perinatal morbidity and mortality.
METHODS
A population-based retrospective cohort analysis of deliveries in Nova Scotia, Canada, between 1980 and 2002 was conducted using the Nova Scotia Atlee Perinatal Database. Risk factors and outcomes for single umbilical artery and isolated single umbilical artery pregnancies were compared with three-vessel-cord pregnancies. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each outcome using multiple logistic regression to adjust for confounding factors. Separate models were run for single umbilical artery and isolated single umbilical artery.
RESULTS
There were 203,240 fetuses and neonates available for analysis, with 885 (0.44%) having single umbilical artery and 725 (0.37%) having isolated single umbilical artery. Single umbilical artery fetuses and neonates had a 6.77 times greater risk of congenital anomalies and 15.35 times greater risk of chromosomal abnormalities. The most common congenital anomalies in chromosomally normal fetuses and neonates were genitourinary (6.48%), followed by cardiovascular (6.25%) and musculoskeletal (5.44%). For isolated single umbilical artery, placental abnormalities (OR 3.63, 95% CI 3.01-4.39), hydramnios (OR 2.80, 95% CI 1.42-5.49), and amniocentesis (OR 2.52, 95% CI 1.82-3.51) occurred more frequently than with three vessel cords. Neonates with single umbilical artery and isolated single umbilical artery had increased rates of prematurity, growth restriction, and adverse neonatal outcomes.
CONCLUSION
Fetuses and neonates with single umbilical artery and isolated single umbilical artery are at increased risk for adverse outcomes. Identification of single umbilical artery is important for prenatal diagnosis of congenital anomalies and aneuploidy. Increased surveillance with isolated single umbilical artery may improve pregnancy outcomes.
LEVEL OF EVIDENCE
II.
目的
确定单脐动脉和单纯性单脐动脉（无染色体异常和结构异常的单脐动脉）胎儿和新生儿的危险因素，并评估其在妊娠、分娩和围生期的并发症风险以及围生儿发病率和死亡率是否增加。
方法
采用加拿大新斯科舍省 1980 年至 2002 年的阿特利围产期数据库，对新斯科舍省的分娩进行了基于人群的回顾性队列分析。将单脐动脉和单纯性单脐动脉妊娠的危险因素和结局与三血管脐带妊娠进行了比较。采用多因素逻辑回归计算每个结局的比值比（OR）和 95%置信区间（CI），以调整混杂因素。分别为单脐动脉和单纯性单脐动脉建立了单独的模型。
结果
共分析了 203240 例胎儿和新生儿，其中 885 例（0.44%）为单脐动脉，725 例（0.37%）为单纯性单脐动脉。单脐动脉胎儿和新生儿发生先天性异常的风险增加 6.77 倍，染色体异常的风险增加 15.35 倍。染色体正常胎儿和新生儿最常见的先天性异常为泌尿生殖系统（6.48%），其次为心血管系统（6.25%）和肌肉骨骼系统（5.44%）。对于单纯性单脐动脉，胎盘异常（OR 3.63，95%CI 3.01-4.39）、羊水过多（OR 2.80，95%CI 1.42-5.49）和羊膜穿刺术（OR 2.52，95%CI 1.82-3.51）的发生率高于三血管脐带。单脐动脉和单纯性单脐动脉新生儿早产、生长受限和不良新生儿结局的发生率增加。
结论
单脐动脉和单纯性单脐动脉胎儿和新生儿发生不良结局的风险增加。识别单脐动脉对先天性异常和非整倍体的产前诊断很重要。对单纯性单脐动脉进行加强监测可能会改善妊娠结局。
证据水平
II 级。
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