脐带脱垂。从诊断到分娩的时间至关重要吗？

Umbilical cord prolapse. Is the time from diagnosis to delivery critical?

作者信息

Prabulos A M, Philipson E H

机构信息

Department of Obstetrics and Gynecology, Hartford Hospital, Connecticut 06115-2700, USA.

出版信息

J Reprod Med. 1998 Feb;43(2):129-32.

PMID:9513874

Abstract

OBJECTIVE

To review the peripartum clinical course of patients whose pregnancies are complicated by umbilical cord prolapse at a large teaching hospital and to evaluate the time from diagnosis to delivery and its impact on neonatal outcome.

STUDY DESIGN

The computerized perinatal database at Hartford Hospital was used to identify all cases of umbilical cord prolapse from 1988 to 1994. Each maternal and neonatal chart was reviewed, and the following variables were evaluated: gestational age, fetal presentation, status of membranes, time from diagnosis to delivery, mode of delivery, type of anesthesia and neonatal outcome.

RESULTS

A total of 65 cases of umbilical cord prolapse were identified from 26,545 deliveries. There were 48 cases of frank cord prolapse and 17 of occult prolapse. Cord prolapse occurred with artificial rupture of membranes in 51% of cases and in 74% of patients at term. There were 59 cesarean births and 6 vaginal deliveries (5 in the occult prolapse group). The mean time from diagnosis to delivery was 20 minutes (range, 2-77). None of the neonates with an occult cord prolapse had a five-minute Apgar score < 7, while 9 (19%) of the neonates with frank prolapse had a five-minute Apgar score < 7. In the frank prolapse group, there were five cases of neonatal asphyxia, all at a gestational age of > or = 36 weeks, and all were delivered by cesarean section. The mean delivery time for these affected neonates was 11 minutes (range, 5-16).

CONCLUSION

Our review indicated that umbilical cord prolapse continues to be associated with poor perinatal outcomes in some cases despite emergency delivery in a modern, high-risk obstetric unit. The asphyxiated neonate had a shorter-than-average time from diagnosis to delivery, suggesting that the time from diagnosis to delivery may not be the only critical determinant of neonatal outcome, particularly with frank cord prolapse. Occult cord prolapse was associated with less perinatal morbidity when compared to frank prolapse.

摘要

目的

回顾一家大型教学医院中妊娠合并脐带脱垂患者的围产期临床过程，并评估从诊断到分娩的时间及其对新生儿结局的影响。

研究设计

利用哈特福德医院的计算机化围产期数据库，识别1988年至1994年间所有脐带脱垂病例。查阅每位产妇和新生儿的病历，并评估以下变量：孕周、胎儿先露、胎膜状态、从诊断到分娩的时间、分娩方式、麻醉类型和新生儿结局。

结果

在26545例分娩中，共识别出65例脐带脱垂病例。其中有48例明显脐带脱垂和17例隐性脱垂。51%的病例脐带脱垂发生在人工破膜时，足月患者中这一比例为74%。有59例剖宫产和6例阴道分娩（隐性脱垂组中有5例）。从诊断到分娩的平均时间为20分钟（范围为2 - 77分钟）。隐性脐带脱垂的新生儿中，无一例5分钟阿氏评分<7分，而明显脱垂的新生儿中有9例（19%）5分钟阿氏评分<7分。在明显脱垂组中，有5例新生儿窒息，均为孕周≥36周，且均通过剖宫产分娩。这些受影响新生儿的平均分娩时间为11分钟（范围为5 - 16分钟）。