单胎和双胎妊娠中单纯帆状脐带附着的围产期结局
Perinatal Outcomes Associated With Isolated Velamentous Cord Insertion in Singleton and Twin Pregnancies.
作者信息
Sinkin Joshua A, Craig Wendy Y, Jones Michael, Pinette Michael G, Wax Joseph R
机构信息
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology.
Maine Medical Center Research Institute, Scarborough, Maine, USA.
出版信息
J Ultrasound Med. 2018 Feb;37(2):471-478. doi: 10.1002/jum.14357. Epub 2017 Aug 29.
OBJECTIVES
To evaluate perinatal outcomes in singleton and twin pregnancies with pathologically confirmed velamentous cord insertion without vasa previa.
METHODS
This retrospective case-control study included all nonanomalous singleton and twin pregnancies with pathologically confirmed velamentous cord insertion delivered in a single institution between January 1, 2005, and July 1, 2015, and having an ultrasound examination by maternal-fetal medicine. For each case, the next 2 consecutive deliveries matched for gestational age at delivery ± 1 week and, in twins, amnionicity and chorionicity served as controls. Primary outcomes included surgical delivery for a nonreassuring intrapartum fetal heart rate tracing, umbilical arterial cord pH of less than 7.2, 5-minute Apgar score of less than 7, birth weight below the 10th percentile, neonatal intensive care unit admission, fetal or neonatal death, and cord avulsion necessitating manual placental extraction.
RESULTS
Outcomes were available for 53 singletons with 103 matched controls and 33 twin pregnancies with 65 matched controls. In singletons, velamentous cord insertion was associated with cord pH of less than 7.2 (odds ratio [OR] 3.5; 95% confidence interval [CI], 1.1-11.2; P = .039), 5-minute Apgar score of less than 7 (OR, 5.3; 95% CI, 0.99-28.1; P = .045), and cord avulsion requiring manual placental extraction (7.5% versus 0%; P = .012). Associations were suggested with increased surgical delivery for a nonreassuring intrapartum fetal heart rate tracing (OR, 2.4; 95% CI, 0.9-6.9; P = .14), birth weight below the 10th percentile (OR, 2.1; 95% CI, 0.8-5.9; P = .21), and fetal or neonatal death (3.8% versus 0%; P = .11). Velamentous cord insertions were also associated with placental abruption in singletons (7.5% versus 0%; P = .013). Among twins, velamentous cord insertion was associated with fetal or neonatal death (9.1% versus 0%; P = .036).
CONCLUSIONS
Isolated confirmed velamentous cord insertion is associated with adverse perinatal outcomes in singleton and twin gestations.
目的
评估经病理证实为帆状脐带附着且无前置血管的单胎和双胎妊娠的围产期结局。
方法
这项回顾性病例对照研究纳入了2005年1月1日至2015年7月1日期间在单一机构分娩、经病理证实为帆状脐带附着且无异常、并接受了母胎医学超声检查的所有单胎和双胎妊娠。对于每例病例，选取接下来连续2例在分娩时孕周匹配（±1周）的分娩病例作为对照，对于双胎妊娠，以羊膜性和绒毛膜性匹配的病例作为对照。主要结局包括因产时胎儿心率监护结果不令人放心而进行的手术分娩、脐动脉血pH值小于7.2、5分钟阿氏评分小于7、出生体重低于第10百分位数、新生儿重症监护病房收治、胎儿或新生儿死亡以及因脐带撕脱需要人工剥离胎盘。
结果
53名单胎妊娠病例及103名匹配对照、33例双胎妊娠病例及65名匹配对照的结局数据可得。在单胎妊娠中，帆状脐带附着与脐动脉血pH值小于7.2（比值比[OR] 3.5；95%置信区间[CI]，1.1 - 11.2；P = 0.039）、5分钟阿氏评分小于7（OR，5.3；95% CI，0.99 - 28.1；P = 0.045）以及因脐带撕脱需要人工剥离胎盘（7.5% 对0%；P = 0.012）相关。有迹象表明，帆状脐带附着与因产时胎儿心率监护结果不令人放心而增加手术分娩（OR，2.4；95% CI，0.9 - 6.9；P = 0.14）、出生体重低于第10百分位数（OR，2.1；95% CI，0.8 - 5.9；P = 0.21）以及胎儿或新生儿死亡（3.8% 对0%；P = 0.11）有关。帆状脐带附着在单胎妊娠中还与胎盘早剥相关（7.5% 对0%；P = 0.013）。在双胎妊娠中，帆状脐带附着与胎儿或新生儿死亡相关（9.1% 对0%；P = 0.036）。
结论
孤立的经证实的帆状脐带附着与单胎和双胎妊娠的不良围产期结局相关。
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