Silver R K, Dooley S L, Tamura R K, Depp R
Am J Obstet Gynecol. 1987 Sep;157(3):716-20. doi: 10.1016/s0002-9378(87)80036-4.
Expectant management of prolonged pregnancy is predicated on reassuring biophysical testing. However, even the combination of a reactive nonstress test and normal amniotic fluid volume may not prevent subsequent morbidity. To test the hypothesis that diminished cord Wharton's jelly incurs risk of peripartum cord compression in addition to decreased amniotic fluid, 68 patients with confirmed gestational age greater than or equal to 41 weeks were evaluated prospectively with semiweekly nonstress tests and weekly ultrasound examinations. Amniotic fluid volume was assessed, and umbilical cord diameter was measured and then correlated with the quantity of Wharton's jelly at delivery, determined by cord circumference. A significant correlation between cord circumference and umbilical cord diameter was observed, even in those patients with decreased amniotic fluid volume. Either an amniotic fluid volume less than 3.8 cm or an umbilical cord diameter less than 1.6 cm was associated with significant cord compression patterns. Peripartum morbidity was greatest in the presence of a smaller cord and decreased fluid, suggesting a synergism between these two factors for the risk of cord compression in prolonged pregnancy.
过期妊娠的期待管理基于可靠的生物物理检测。然而，即使无应激试验呈反应型且羊水容量正常，也未必能预防随后的发病情况。为验证如下假说，即除羊水减少外，脐带华通胶减少会增加围产期脐带受压风险，我们对68例确诊孕周大于或等于41周的患者进行了前瞻性评估，每半周进行一次无应激试验，每周进行一次超声检查。评估羊水容量，测量脐带直径，然后将其与分娩时华通胶的量相关联，后者由脐带周长确定。即使在羊水减少的患者中，也观察到脐带周长与脐带直径之间存在显著相关性。羊水容量小于3.8 cm或脐带直径小于1.6 cm均与明显的脐带受压模式相关。在脐带较细且羊水减少的情况下，围产期发病率最高，这表明这两个因素在过期妊娠脐带受压风险方面存在协同作用。
