Schreiber Hanoch, Cohen Gal, Mevorach Nir, Shavit Maya, Kovo Michal, Biron-Shental Tal, Markovitch Ofer
Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., Kfar Saba 44281, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
J Clin Med. 2022 Nov 25;11(23):6970. doi: 10.3390/jcm11236970.
This retrospective cohort study assessed the association between nuchal cord and adverse outcomes during vacuum-assisted delivery (VAD). Women with singleton pregnancies, 34−41-weeks gestation, who underwent VAD, from 2014 to 2020 were included. The primary outcome was umbilical cord pH ≤ 7.1. Secondary outcomes were neonatal intensive care unit admission, Apgar scores, pH < 7.15, subgaleal hematoma, shoulder dystocia and third/fourth-degree perineal tear. Outcomes were compared between neonates with (1059/3754, 28.2%) or without (71.8%) nuchal cord after VAD. No difference in cord pH ≤ 7.1 was found between groups. The nuchal cord group had a lower rate of nulliparity (729 (68.8%) vs. 2004 (74.4%), p = 0.001) and higher maternal BMI (23.6 ± 4.3 vs. 23.1 ± 5, p = 0.017). Nuchal cord was associated with higher rates of induction (207 (19.5%) vs. 431 (16%), p = 0.009) and lower birthweights (3185 ± 413 vs. 3223 ± 436 g, p = 0.013). The main indication for VAD in 830 (80.7%) of the nuchal cord group was non-reassuring fetal heart rate (NRFHR) vs. 1989 (75.6%) controls (p = 0.004). The second stage was shorter in the nuchal cord group (128 ± 81 vs. 141 ± 80 min, p < 0.001). Multivariate regression found nulliparity, induction and birthweight as independent risk factors for nuchal cord VAD. Although induction and NRFHR rates were higher in VAD with nuchal cord, the rate of umbilical cord acidemia was not.
这项回顾性队列研究评估了真空辅助分娩（VAD）期间脐带绕颈与不良结局之间的关联。纳入了2014年至2020年期间接受VAD的单胎妊娠、妊娠34 - 41周的女性。主要结局是脐动脉血pH≤7.1。次要结局包括新生儿重症监护病房入院、阿氏评分、pH<7.15、帽状腱膜下血肿、肩难产和会阴三度/四度撕裂。比较了VAD后有（1059/3754，28.2%）或无（71.8%）脐带绕颈的新生儿的结局。两组之间脐动脉血pH≤7.1无差异。脐带绕颈组初产妇比例较低（729例（68.8%）对2004例（74.4%），p = 0.001），产妇体重指数较高（23.6±4.3对23.1±5，p = 0.017）。脐带绕颈与更高的引产率（207例（19.5%）对431例（16%），p = 0.009）和更低的出生体重相关（3185±413对3223±436 g，p = 0.013）。脐带绕颈组830例（80.7%）VAD的主要指征是胎儿心率异常（NRFHR），而对照组为1989例（75.6%）（p = 0.004）。脐带绕颈组第二产程较短（128±81对141±80分钟，p<0.001）。多因素回归分析发现初产妇、引产和出生体重是脐带绕颈VAD的独立危险因素。尽管脐带绕颈的VAD中引产和NRFHR率较高，但脐动脉血酸中毒率并非如此。
