Strong T H, Finberg H J, Mattox J H
Phoenix Perinatal Associates, Good Samaritan Regional Medical Center, AZ 85006.
Am J Obstet Gynecol. 1994 Jun;170(6):1729-31; discussion 1731-3.
The null hypothesis is that fetuses with noncoiled umbilical cords diagnosed in the antepartum period will have outcomes no different from those with normally coiled cords.
We prospectively gathered data from Jan. 1 through May 18, 1992, from all fetuses undergoing routine ultrasonographic evaluation. The outcomes of fetuses noted to have noncoiled umbilical cords were compared with those of a control group of fetuses with normally coiled cords. The control group consisted of those subjects undergoing ultrasonography during the study period who were ultimately transferred to our perinatal practice for the remainder of the pregnancy (i.e., the highest-risk patients). Two outcome parameters were selected for comparison: fetal anomalies and fetal death.
Six hundred eighty-seven consecutive ultrasonographic examinations were performed. Twenty-five subjects (3.7%) had noncoiled umbilical cords identified ultrasonographically (mean gestational age at diagnosis 20.3 +/- 3.5 [SD] weeks). The control group had 197 subjects. The combined incidence of fetal anomalies or death in the noncoiled group (16%) was significantly greater (p < or = 0.05, relative risk 4.6 [95% confidence interval 1.41 to 14.15]) than that of the control group (3.5%). The noncoiled group had two fetal deaths (8%), whereas two deaths (1%) occurred among controls (p < or = 0.05, relative risk 8 [95% confidence interval 1.16 to 50]). Two (8%) fetal anomalies (anencephaly, prune-belly syndrome) occurred in the noncoiled group, whereas the controls (n = 197) had five fetuses (2.5%) with anomalies (not significant).
The antepartum identification of noncoiled umbilical cords appears to be a risk factor for suboptimal pregnancy outcome.
无效假设是产前诊断为脐带未卷曲的胎儿其结局与脐带正常卷曲的胎儿无异。
我们前瞻性收集了1992年1月1日至5月18日期间所有接受常规超声检查的胎儿的数据。将被发现脐带未卷曲的胎儿的结局与脐带正常卷曲的对照组胎儿的结局进行比较。对照组由研究期间接受超声检查并最终在妊娠剩余时间转入我们围产期医疗服务机构的受试者组成（即风险最高的患者）。选择了两个结局参数进行比较：胎儿畸形和胎儿死亡。
共进行了687次连续超声检查。25名受试者（3.7%）超声检查发现脐带未卷曲（诊断时平均孕周20.3±3.5[标准差]周）。对照组有197名受试者。脐带未卷曲组胎儿畸形或死亡的合并发生率（16%）显著高于对照组（3.5%）（p≤0.05，相对风险4.6[95%置信区间1.41至14.15]）。脐带未卷曲组有2例胎儿死亡（8%），而对照组有2例死亡（1%）（p≤0.05，相对风险8[95%置信区间1.16至50]）。脐带未卷曲组发生2例（8%）胎儿畸形（无脑儿、梅干腹综合征），而对照组（n = 197）有5例胎儿（2.5%）有畸形（无统计学意义）。
产前识别脐带未卷曲似乎是妊娠结局不佳的一个危险因素。
