Abdallah A, Eldorf A, Sallam S, Ahmed S, Shawky M, Nawara M, El-Sayed M, Islam Ba, Abdelrahman R, Sabaa H, BahaaEldin A, Yehia A, Rateb A, Sakna N, Mamdouh A, Taema M, Elshourbagy M, Alanwar A
a Department of Obstetrics and Gynecology , Minia University , Minia , Egypt.
b Department of Obstetrics and Gynecology , Tanta University , Elgharbya , Egypt.
J Matern Fetal Neonatal Med. 2019 Oct;32(20):3367-3378. doi: 10.1080/14767058.2018.1463984. Epub 2018 Apr 25.
The purpose of this study is to investigate the use of a more biologic parameter for evaluation of the effect of nuchal cord tightness; the study of blood flow in the umbilical arteries of nuchal cord using Doppler ultrasonography. This prospective cohort study was conducted at Ain Shams University Maternity Hospital, Cairo, Egypt in the period between August 2015 and August 2017. Hundred primigravidas were recruited with nuchal cord diagnosed by Doppler ultrasonography; whereas the rest of the study population was included in the "Control group". Doppler velocimetry study was then performed on a free-floating loop of the umbilical cord and Doppler indices were calculated. Both groups were followed up during labor: intrapartum events, mode of delivery, and neonatal outcome were recorded. Intrapartum fetal heart rate abnormalities were significantly more common in the nuchal cord group compared to the control group. The overall cardiotocography category was significantly more commonly reflecting abnormal fetal heart rate patterns in the nuchal cord group compared to the control group with 46.74% of the nuchal group patients falling within the "suspicious - pathological - need urgent intervention" categories. Intervention rate was significantly higher in the nuchal cord group than the control group (33.69 versus 21.84%). Moreover, incidence of intrapartum fetal heart rate abnormalities and intervention rate were significantly higher in the nuchal cord with abnormal Doppler subgroup compared to both nuchal cord with normal Doppler subgroup and the control group; with a calculated number needed to harm of 2.11. In view of these results, it might be concluded that umbilical cord tightness affecting fetal hemodynamics (expressed by changes in umbilical artery Doppler) might be a determinate factor affecting the intrapartum course.
本研究的目的是探讨使用一种更具生物学特性的参数来评估脐带绕颈的影响；利用多普勒超声研究脐带绕颈时脐动脉的血流情况。这项前瞻性队列研究于2015年8月至2017年8月在埃及开罗艾因夏姆斯大学妇产医院进行。招募了100例经多普勒超声诊断为脐带绕颈的初产妇；其余研究对象纳入“对照组”。然后对脐带的自由浮动环进行多普勒测速研究并计算多普勒指数。两组在分娩期间均进行随访：记录产时事件、分娩方式和新生儿结局。与对照组相比，脐带绕颈组产时胎儿心率异常更为常见。与对照组相比，脐带绕颈组总体胎心监护类别更常反映异常胎儿心率模式，脐带绕颈组46.74%的患者属于“可疑 - 病理 - 需要紧急干预”类别。脐带绕颈组的干预率显著高于对照组（33.69%对21.84%）。此外，与多普勒正常的脐带绕颈亚组和对照组相比，多普勒异常的脐带绕颈亚组产时胎儿心率异常发生率和干预率显著更高；计算得出伤害所需人数为2.11。鉴于这些结果，可以得出结论，影响胎儿血流动力学的脐带紧度（通过脐动脉多普勒变化表示）可能是影响产时过程的一个决定性因素。
