Młodawska Marta, Młodawski Jakub, Świercz Grzegorz, Zieliński Rafał
Collegium Medicum, Jan Kochanowski University in Kielce, 25-369 Kielce, Poland.
Pediatr Rep. 2022 Jan 24;14(1):40-47. doi: 10.3390/pediatric14010007.
Objective: The twisting of the umbilical cord around the fetal neck is a common phenomenon in the delivery room, and despite the lack of univocal evidence of its negative impact on perinatal events, it causes anxiety and stress in patients. The aim of the study was to assess the prevalence of nuchal cord and its impact on adverse obstetric and neonatal outcomes. Methods: We conducted a retrospective cohort study. All patients who gave birth in the clinic within one year (n = 1467) were included in the study group. We compared the prevalence of nuchal cord in distinct subgroups of patients. In the next stage, we estimated the chance of specific perinatal outcomes and compared the neonatal outcomes between groups with and without nuchal cord. Results: Nuchal cord was present in 24% of labors. It was twice as common among patients giving birth vaginally (32.14%) than among patients giving birth by a caesarean section (16.78%, p < 0.001). Nuchal cord was also more frequent in births with meconium-stained amniotic fluid (33.88% vs. 23.34%, p = 0.009). In the group of patients with nuchal cord, we observed a slight increase in the risk of a non-reassuring fetal heart rate trace (OR = 1.55, CI 95% 1.02−2.36) as an indication of the completion of labor by caesarean delivery. We did not note an increase in the risk of completing natural childbirth by vacuum extraction. In the group of nuchal cord patients, there was a higher chance of a serious or moderate neonatal condition in the first minute of life (Apgar 0−7 points) (OR = 2.00, 95% CI = 1.14−3.49). Conclusions: Nuchal cord increases the risk of a caesarean delivery due to a non-reassuring fetal heart rate trace. Nuchal cord increases the chance of a reduced Apgar score (0−7 points) in the first minute of life. The observed relationships do not translate to neonatal arterial blood gas testing.
脐带绕颈是产房常见现象，尽管尚无确凿证据表明其对围产期事件有负面影响，但它会引起患者焦虑和压力。本研究旨在评估脐带绕颈的发生率及其对不良产科和新生儿结局的影响。方法：我们进行了一项回顾性队列研究。研究组纳入了一年内（n = 1467）在该诊所分娩的所有患者。我们比较了不同亚组患者中脐带绕颈的发生率。在下一阶段，我们估计了特定围产期结局的可能性，并比较了有脐带绕颈组和无脐带绕颈组之间的新生儿结局。结果：24%的分娩存在脐带绕颈。经阴道分娩的患者中脐带绕颈的发生率（32.14%）是剖宫产患者（16.78%）的两倍（p < 0.001）。羊水粪染的分娩中脐带绕颈也更常见（33.88%对23.34%，p = 0.009）。在脐带绕颈患者组中，我们观察到胎儿心率异常（作为剖宫产指征）的风险略有增加（OR = 1.55，95%CI 1.02 - 2.36）。我们未发现真空吸引完成自然分娩的风险增加。在脐带绕颈患者组中，出生后第一分钟出现严重或中度新生儿状况（阿氏评分0 - 7分）的可能性更高（OR = 2.00，95%CI = 1.14 - 3.49）。结论：脐带绕颈因胎儿心率异常增加了剖宫产的风险。脐带绕颈增加了出生后第一分钟阿氏评分降低（0 - 7分）的可能性。观察到的这些关系与新生儿动脉血气检测无关。
