FETALMED - Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile.
J Matern Fetal Neonatal Med. 2021 Oct;34(19):3246-3251. doi: 10.1080/14767058.2019.1659773. Epub 2019 Sep 16.
To determine the antenatal course and perinatal outcome of pregnancies in which a triple nuchal cord was detected prenatally by ultrasound.
Singleton pregnancies presenting for ultrasound evaluation after 24 weeks of gestation were routinely screened for the presence of nuchal cord loops using two-dimensional and color-Doppler ultrasound. Fetuses with more than two nuchal cord loops were identified from our fetal medicine database and their ultrasound reports and medical records were reviewed.
During the study period from July 2014 to February 2019, 10 singleton fetuses with triple nuchal cord were identified, for a prevalence of 1 in 506 or 0.2%. No cases of more than three nuchal cord loops were detected. No predisposing factors were identified. Cases detected after 36 weeks ( = 4) delivered by cesarean section after 37 weeks and the diagnosis of triple nuchal cord was confirmed in all of them. Cases detected before 36 weeks ( = 6) underwent fetal surveillance. Among these cases, the umbilical cord unraveled itself from around the fetal neck in at least one loop in 83% of these cases. Overall, eight (80%) of the neonates were delivered by cesarean section for different reasons; in only two, the sole indication for cesarean delivery was the presence of the triple nuchal cord. All the infants had a good perinatal outcome, although one newborn infant was small for gestational age.
Ultrasound detection of triple nuchal cord during late pregnancy was associated with good perinatal outcomes. However, this prenatal finding was also associated with a high rate of cesarean section. In preterm pregnancies, multiple loops will reduce spontaneously in the majority of cases, so expectant management is indicated. In term pregnancies, the decision regarding the optimal timing and mode of delivery should be discussed with the parents taking into account the individual clinical scenarios.
确定通过超声产前检测到三圈脐带缠绕的妊娠的产前过程和围产儿结局。
对 24 孕周后进行超声检查的单胎妊娠常规进行二维和彩色多普勒超声检查，以筛查是否存在脐带缠绕。从我们的胎儿医学数据库中识别出有多于两圈脐带缠绕的胎儿，并对其超声报告和病历进行回顾。
在 2014 年 7 月至 2019 年 2 月的研究期间，共发现 10 例三圈脐带缠绕的单胎胎儿，患病率为 1/506，即 0.2%。未发现三圈以上的脐带缠绕。未发现任何诱发因素。36 孕周以后（4 例）的病例在 37 孕周后行剖宫产分娩，均确诊为三圈脐带缠绕。36 孕周以前（6 例）的病例行胎儿监护。这些病例中，至少有 83%的病例中脐带缠绕在胎儿颈部的一圈自行解开。总的来说，8（80%）例新生儿因不同原因行剖宫产分娩，仅 2 例剖宫产的唯一指征是存在三圈脐带缠绕。所有新生儿的围产儿结局良好，尽管有 1 例新生儿为小于胎龄儿。
妊娠晚期超声检测到三圈脐带缠绕与良好的围产儿结局相关。然而，这种产前发现也与较高的剖宫产率相关。在早产妊娠中，大多数情况下多圈会自发减少，因此应进行期待治疗。在足月妊娠中，应根据个体临床情况与父母讨论最佳的分娩时机和方式。
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