背景胎动(FM)是唯一依赖孕妇自我评估的主观性指标,却可客观反映胎儿宫内安全情况;如何将FM量化并使其成为一个相对客观的评价指标一直是产科医师研究和关注的焦点。目的通过应用日常胎动记录图(DFMC)预测和评估脐带绕颈胎儿的宫内安危...背景胎动(FM)是唯一依赖孕妇自我评估的主观性指标,却可客观反映胎儿宫内安全情况;如何将FM量化并使其成为一个相对客观的评价指标一直是产科医师研究和关注的焦点。目的通过应用日常胎动记录图(DFMC)预测和评估脐带绕颈胎儿的宫内安危。方法回顾性选取2010年1月—2016年1月在浙江衢化医院住院分娩的足月孕妇100例,分娩前B超和分娩后临床均证实胎儿脐带绕颈。分析孕妇分娩前24 h DFMC,并根据FM情况预测胎儿宫内是否安全:FM规律定义为宫内安全;FM异常、减少或消失均定义为宫内不安全。收集孕妇一般资料,包括年龄、孕周、超声下脐动脉收缩期与舒张期血流比值(S/D值)、羊水指数(AFI),同时行临产前24 h无应激试验(NST)并予以改良Fischer评分法评分,采集分娩后围生儿结局情况、分娩方式(自然阴道、剖宫产、产钳助产)。根据分娩后围生儿结局分为胎儿宫内安全组(44例)和胎儿宫内不安全组(56例),采用多因素Logistic逐步回归分析探究脐带绕颈胎儿宫内安全的影响因素。结果两组S/D值、脐带绕颈周数、FM、改良Fischer评分法评分、分娩方式比较,差异均有统计学意义(P<0.05)。多因素Logistic逐步回归分析结果显示,FM和分娩方式是脐带绕颈胎儿宫内安危的影响因素(P<0.05)。DFMC预测自然分娩的脐带绕颈胎儿宫内安全的灵敏度为86.5%,特异度为90.0%,约登指数为0.77;DFMC预测剖宫产的脐带绕颈胎儿宫内安全的灵敏度为66.7%,特异度为94.6%,约登指数为0.61。FM异常、减少或消失者剖宫产比例为87.5%(35/40)。结论DFMC可以有效预测和评价脐带绕颈胎儿宫内安危,同时亦可为胎儿脐带绕颈的孕妇分娩方式的选择提供有限的临床依据。展开更多
Objective: The present study was aimed at evaluating the outcome of pregnancies with a nuchal cord. Methods: A retrospective population-based study of all deliveries during the years 2011-2020 in Philippe Maguilen SEN...Objective: The present study was aimed at evaluating the outcome of pregnancies with a nuchal cord. Methods: A retrospective population-based study of all deliveries during the years 2011-2020 in Philippe Maguilen SENGHOR Center was conducted. Perinatal outcome of patients with and without nuchal cord was compared. Results: Among 44,958 deliveries during the study period, 1.8% had a nuchal cord, documented at birth (n = 807). Higher rates of labor induction (9.1% vs. 3.2%;p 0.001) and non-reassuring fetal heart rate patterns (RR = 2.366;CI: 1.631 - 3.432) were noted among pregnancies with nuchal cord as compared with the control group. The cesarean delivery rate was significantly higher among pregnancies with a nuchal cord (39.5% vs. 21.8%;RR = 2333;CI: 2.023 - 2.692). Although 5 min Apgar scores lower than 7 were more common in pregnancies with a nuchal cord (7.8% vs. 3.8%;RR = 2.117;CI: 1.629 - 3.363). There was no statistical significance between the two groups for the perinatal mortality. Conclusion: Nuchal cord is associated with prolonged labor and adverse perinatal outcome.展开更多
Introduction: Our aim was to identify the risk factors of clinical birth asphyxia and subsequent newborn death in the presence of nuchal cord in a sub-Saharan Africa setting. Methodology: It was a six-months’ case-co...Introduction: Our aim was to identify the risk factors of clinical birth asphyxia and subsequent newborn death in the presence of nuchal cord in a sub-Saharan Africa setting. Methodology: It was a six-months’ case-control study involving 117 parturients whose babies presented with a nuchal cord at delivery. The study was carried out at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon, from January 1st to June 30th 2013. Results: The risk factors of clinical birth asphyxia identified were: first delivery, absence of obstetrical ultrasound during pregnancy, nuchal cord with more than one loop, duration of second stage of labor more than 30 minutes during vaginal delivery. The risk factors for newborn death from clinical birth asphyxia in the presence of nuchal cord were: maternal age Conclusion: We recommend a systematic obstetrical ultrasound before labor, so as to detect the presence of a nuchal cord, its tightness and the number of loops. Also, cesarean section should be considered when a nuchal cord is associated with first delivery, tightness or multiple looping.展开更多
文摘背景胎动(FM)是唯一依赖孕妇自我评估的主观性指标,却可客观反映胎儿宫内安全情况;如何将FM量化并使其成为一个相对客观的评价指标一直是产科医师研究和关注的焦点。目的通过应用日常胎动记录图(DFMC)预测和评估脐带绕颈胎儿的宫内安危。方法回顾性选取2010年1月—2016年1月在浙江衢化医院住院分娩的足月孕妇100例,分娩前B超和分娩后临床均证实胎儿脐带绕颈。分析孕妇分娩前24 h DFMC,并根据FM情况预测胎儿宫内是否安全:FM规律定义为宫内安全;FM异常、减少或消失均定义为宫内不安全。收集孕妇一般资料,包括年龄、孕周、超声下脐动脉收缩期与舒张期血流比值(S/D值)、羊水指数(AFI),同时行临产前24 h无应激试验(NST)并予以改良Fischer评分法评分,采集分娩后围生儿结局情况、分娩方式(自然阴道、剖宫产、产钳助产)。根据分娩后围生儿结局分为胎儿宫内安全组(44例)和胎儿宫内不安全组(56例),采用多因素Logistic逐步回归分析探究脐带绕颈胎儿宫内安全的影响因素。结果两组S/D值、脐带绕颈周数、FM、改良Fischer评分法评分、分娩方式比较,差异均有统计学意义(P<0.05)。多因素Logistic逐步回归分析结果显示,FM和分娩方式是脐带绕颈胎儿宫内安危的影响因素(P<0.05)。DFMC预测自然分娩的脐带绕颈胎儿宫内安全的灵敏度为86.5%,特异度为90.0%,约登指数为0.77;DFMC预测剖宫产的脐带绕颈胎儿宫内安全的灵敏度为66.7%,特异度为94.6%,约登指数为0.61。FM异常、减少或消失者剖宫产比例为87.5%(35/40)。结论DFMC可以有效预测和评价脐带绕颈胎儿宫内安危,同时亦可为胎儿脐带绕颈的孕妇分娩方式的选择提供有限的临床依据。
文摘Objective: The present study was aimed at evaluating the outcome of pregnancies with a nuchal cord. Methods: A retrospective population-based study of all deliveries during the years 2011-2020 in Philippe Maguilen SENGHOR Center was conducted. Perinatal outcome of patients with and without nuchal cord was compared. Results: Among 44,958 deliveries during the study period, 1.8% had a nuchal cord, documented at birth (n = 807). Higher rates of labor induction (9.1% vs. 3.2%;p 0.001) and non-reassuring fetal heart rate patterns (RR = 2.366;CI: 1.631 - 3.432) were noted among pregnancies with nuchal cord as compared with the control group. The cesarean delivery rate was significantly higher among pregnancies with a nuchal cord (39.5% vs. 21.8%;RR = 2333;CI: 2.023 - 2.692). Although 5 min Apgar scores lower than 7 were more common in pregnancies with a nuchal cord (7.8% vs. 3.8%;RR = 2.117;CI: 1.629 - 3.363). There was no statistical significance between the two groups for the perinatal mortality. Conclusion: Nuchal cord is associated with prolonged labor and adverse perinatal outcome.
文摘Introduction: Our aim was to identify the risk factors of clinical birth asphyxia and subsequent newborn death in the presence of nuchal cord in a sub-Saharan Africa setting. Methodology: It was a six-months’ case-control study involving 117 parturients whose babies presented with a nuchal cord at delivery. The study was carried out at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon, from January 1st to June 30th 2013. Results: The risk factors of clinical birth asphyxia identified were: first delivery, absence of obstetrical ultrasound during pregnancy, nuchal cord with more than one loop, duration of second stage of labor more than 30 minutes during vaginal delivery. The risk factors for newborn death from clinical birth asphyxia in the presence of nuchal cord were: maternal age Conclusion: We recommend a systematic obstetrical ultrasound before labor, so as to detect the presence of a nuchal cord, its tightness and the number of loops. Also, cesarean section should be considered when a nuchal cord is associated with first delivery, tightness or multiple looping.
