Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.
Am J Perinatol. 2020 Mar;37(4):378-383. doi: 10.1055/s-0039-1679866. Epub 2019 Feb 28.
This study aimed to determine the association between nuchal cord, electronic fetal monitoring parameters, and adverse neonatal outcomes.
This was a prospective cohort study of 8,580 singleton pregnancies. Electronic fetal monitoring was interpreted, and patients with a nuchal cord at delivery were compared with those without. The primary outcome was a composite neonatal morbidity index. Logistic regression was used to adjust for confounders.
Of 8,580 patients, 2,071 (24.14%) had a nuchal cord. There was no difference in the risk of neonatal composite morbidity in patients with or without a nuchal cord (8.69 vs. 8.86%; = 0.81). Nuchal cord was associated with category II fetal heart tracing and operative vaginal delivery (OVD) (6.4 vs. 4.3%; < 0.01).
Nuchal cord is associated with category II electronic fetal monitoring parameters, which may drive increased rates of OVD. However, there is no significant association with neonatal morbidity.
本研究旨在探讨脐带绕颈、电子胎心监护参数与不良新生儿结局之间的关系。
这是一项 8580 例单胎妊娠的前瞻性队列研究。对电子胎心监护进行解读，并比较分娩时存在脐带绕颈与不存在脐带绕颈的患者。主要结局为新生儿复合发病率指数。采用逻辑回归调整混杂因素。
8580 例患者中，2071 例（24.14%）存在脐带绕颈。有或无脐带绕颈的新生儿复合发病率无差异（8.69%比 8.86%； = 0.81）。脐带绕颈与Ⅱ类胎心监护图和阴道助产分娩（operative vaginal delivery，OVD）相关（6.4%比 4.3%； < 0.01）。
脐带绕颈与Ⅱ类电子胎心监护参数相关，这可能导致 OVD 发生率增加。然而，与新生儿发病率并无显著关联。
