脐带异常与死胎。
Umbilical Cord Abnormalities and Stillbirth.
机构信息
Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, University of Utah Healthcare, and Intermountain Healthcare, Salt Lake City, UT; the Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, New York; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia; RTI International, Research Triangle Park, North Carolina; the University of Texas Health Science Center at San Antonio, San Antonio, Texas; the Division of Perinatal and Pediatric Pathology, Women and Infants Hospital, the Warren Alpert School of Medicine of Brown University, Providence, Rhode Island; and the Division of Pediatric Pathology, Department of Pathology, Primary Children's Medical Center, Intermountain Healthcare and University of Utah Health, Salt Lake City, Utah.
出版信息
Obstet Gynecol. 2020 Mar;135(3):644-652. doi: 10.1097/AOG.0000000000003676.
OBJECTIVE
Umbilical cord abnormalities are commonly cited as a cause of stillbirth, but details regarding these stillbirths are rare. Our objective was to characterize stillbirths associated with umbilical cord abnormalities using rigorous criteria and to examine associated risk factors.
METHODS
The Stillbirth Collaborative Research Network conducted a case-control study of stillbirth and live births from 2006 to 2008. We analyzed stillbirths that underwent complete fetal and placental evaluations and cause of death analysis using the INCODE (Initial Causes of Fetal Death) classification system. Umbilical cord abnormality was defined as cord entrapment (defined as nuchal, body, shoulder cord accompanied by evidence of cord occlusion on pathologic examination); knots, torsions, or strictures with thrombi, or other obstruction by pathologic examination; cord prolapse; vasa previa; and compromised fetal microcirculation, which is defined as a histopathologic finding that represents objective evidence of vascular obstruction and can be used to indirectly confirm umbilical cord abnormalities when suspected as a cause for stillbirth. We compared demographic and clinical factors between women with stillbirths associated with umbilical cord abnormalities and those associated with other causes, as well as with live births. Secondarily, we analyzed the subset of pregnancies with a low umbilical cord index.
RESULTS
Of 496 stillbirths with complete cause of death analysis by INCODE, 94 (19%, 95% CI 16-23%) were associated with umbilical cord abnormality. Forty-five (48%) had compromised fetal microcirculation, 27 (29%) had cord entrapment, 26 (27%) knots, torsions, or stricture, and five (5%) had cord prolapse. No cases of vasa previa occurred. With few exceptions, maternal characteristics were similar between umbilical cord abnormality stillbirths and non-umbilical cord abnormality stillbirths and between umbilical cord abnormality stillbirths and live births, including among a subanalysis of those with hypo-coiled umbilical cords.
CONCLUSION
Umbilical cord abnormalities are an important risk factor for stillbirth, accounting for 19% of cases, even when using rigorous criteria. Few specific maternal and clinical characteristics were associated with risk.
目的
脐带异常通常被认为是导致死胎的原因，但这些死胎的详细信息却很少见。我们的目的是使用严格的标准来描述与脐带异常相关的死胎，并研究相关的危险因素。
方法
Stillbirth Collaborative Research Network 于 2006 年至 2008 年期间进行了一项关于死产和活产的病例对照研究。我们使用 INCODE（胎儿死亡初始原因）分类系统分析了经过完整胎儿和胎盘评估以及死因分析的死产病例。脐带异常定义为脐带缠绕（定义为颈后、体部、肩部脐带伴有病理检查发现的脐带闭塞）；病理检查发现的脐带结节、扭曲或狭窄伴血栓形成，或其他梗阻；脐带脱垂；血管前置；以及胎儿微循环受损，定义为代表血管阻塞客观证据的组织病理学发现，当怀疑为死产的原因时，可用于间接确认脐带异常。我们比较了与脐带异常相关的死产妇女与与其他原因相关的死产妇女以及活产妇女的人口统计学和临床因素。其次，我们分析了脐带指数较低的妊娠亚组。
结果
在通过 INCODE 进行完整死因分析的 496 例死产中，94 例（19%，95%CI 16-23%）与脐带异常相关。45 例（48%）有胎儿微循环受损，27 例（29%）有脐带缠绕，26 例（27%）有脐带结节、扭曲或狭窄，5 例（5%）有脐带脱垂。没有血管前置的病例。除了少数例外，脐带异常死产妇女与非脐带异常死产妇女以及脐带异常死产妇女与活产妇女的母体特征相似，包括在脐带指数较低的亚组分析中也是如此。
结论
即使使用严格的标准，脐带异常也是死胎的一个重要危险因素，占 19%。很少有特定的母体和临床特征与风险相关。
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