Porat Shay, Kabiri Doron, Karavani Gilad, Amsalem Hagai, Lipschuetz Michal, Rosenbloom Joshua I
Department of Obstetrics and Gynecology, Hadassah Ein Kerem Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel.
Department of Obstetrics and Gynecology, Hadassah Mt Scopus Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel.
Arch Gynecol Obstet. 2025 Oct;312(4):1175-1183. doi: 10.1007/s00404-025-08110-7. Epub 2025 Jul 11.
To quantify the risk of true cord of the umbilical cord for perinatal death and identify additional risk factors.
This retrospective study included singleton deliveries between 24 and 42 weeks of gestation that took place between 2003 and 2017 in two medical centers. For patients with true knot, data regarding the number of cord knots as well as the location and number of loops of cord were obtained. The rest of the birth data set comprised the control group. The primary outcome was fetal demise. Secondary outcomes included mode of delivery and perinatal outcomes.
The final data set included 139,458 deliveries, of which 364 cases (0.26%) comprised the study group (true knot group) and 139,094 cases (99.74%) the control group. Higher rated of unfavorable outcomes were found among cases than controls, including perinatal death, delivery mode, lower Apgar and cord blood umbilical artery pH as well as higher rates of NICU admission and perinatal death. Multivariate analysis showed that true knot of cord (aOR 15.46, 95% CI 9.30-25.70) was a strong predictor of perinatal death. Analysis of predictors of perinatal death within the study group showed that only four or more nuchal loops of cord was an independent predictor (four loops OR 13.40 95% CI 1.12-160.34).
True knot of the umbilical cord is a strong predictor of perinatal death. Fetuses with true knot of cord and four or more nuchal cord loops are at significantly increased risk of perinatal death. If diagnosed before onset of labor, delivery before 37 weeks may prevent perinatal death.
量化脐带真结导致围产期死亡的风险，并确定其他风险因素。
这项回顾性研究纳入了2003年至2017年在两家医疗中心发生的妊娠24至42周的单胎分娩。对于有真结的患者，获取了脐带结的数量以及脐带环的位置和数量的数据。其余的出生数据集构成对照组。主要结局是胎儿死亡。次要结局包括分娩方式和围产期结局。
最终数据集包括139458例分娩，其中364例（0.26%）为研究组（真结组），139094例（99.74%）为对照组。研究组不良结局的发生率高于对照组，包括围产期死亡、分娩方式、较低的阿氏评分和脐动脉血pH值，以及较高的新生儿重症监护病房（NICU）入住率和围产期死亡率。多因素分析显示，脐带真结（调整后比值比[aOR]为15.46，95%置信区间[CI]为9.30 - 25.70）是围产期死亡的有力预测因素。对研究组内围产期死亡预测因素的分析表明，只有四个或更多的脐带颈部环是独立预测因素（四个环的比值比为13.40，95% CI为1.12 - 160.34）。
脐带真结是围产期死亡的有力预测因素。有脐带真结且有四个或更多脐带颈部环的胎儿围产期死亡风险显著增加。如果在临产前诊断，37周前分娩可能预防围产期死亡。
