【摘要】 目的 探讨单胎与双胎脐带真结的高危因素、超声检查及妊娠结局。方法 回顾性分析2015年11月至2022年5月在华中科技大学同济医学院附属同济医院诊断为脐带真结的19例单胎(单胎真结组)、11例双胎(双胎真结组)的病例资料，分别有3例单胎、1例双胎经产前超声拟诊断为脐带真结，分析其超声图像。分别以同一时期入院的无脐带真结的775例(单胎无真结组)、94例(双胎无真结组)孕妇作为对照。分别对比两组的基本资料、妊娠期合并症及并发症，探讨单胎与双胎脐带真结的高危因素及妊娠结局。结果 (1)单胎真结组体外受精-胚胎移植(IVF-ET)术、妊娠期高血压疾病(hypertensive disorders of pregnancy, HDP)、羊水过少、羊水过多、胎儿生长受限(fetal growth restriction, FGR)、脐带绕颈的发生率高于单胎无真结组，差异均有统计学意义(均P<0.05)。多因素Logistic回归分析示：羊水过少、羊水过多、脐带绕颈是单胎脐带真结的独立危险因素(OR>1,均P<0.05)。(2)与双胎无真结组比较，双胎真结组单绒单羊(monochorionic monoamnionic, MCMA)的发生率更高，IVF-ET术、双绒双羊(dichorionic diamniotic, DCDA)的发生率更低(均P<0.05)。多因素Logistic回归分析示：单绒单羊是双胎脐带真结的独立危险因素(OR>1,P<0.05)。(3)脐带真结超声图像表现为脐带立体扭曲缠绕成盘曲团状或“麻花”样，脐血管走行方向杂乱交叉。(4)单胎真结组羊水Ⅲ度污染的发生率较单胎无真结组更高(P<0.05),双胎组两组妊娠结局差异无统计学意义。结论 羊水过少、羊水过多、脐带绕颈和单绒单羊分别是单胎、双胎脐带真结的高危因素。脐带立体扭曲缠绕成盘曲团状或“麻花”样，脐血管走行方向杂乱交叉，应高度怀疑脐带真结。单胎脐带真结羊水Ⅲ度污染的风险更高，新生儿结局均无明显差异。更多还原

【Abstract】 Objective To investigate the risk factors, ultrasonography results and pregnancy outcomes of true umbilical cord knot in singleton and twin fetus.Methods The data of 19 singleton(singleton group)and 11 twin(twin group)cases diagnosed with true umbilical cord knot in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from November 2015 to May 2022 were retrospectively analyzed.There were 3 singleton cases and 1 twin case diagnosed with true umbilical cord knot by prenatal ultrasonography, respectively, and the ultrasound images were analyzed.Totally, 775 cases(singleton group)and 94 cases(twin group)admitted to hospital in the same period without true umbilical cord knot were taken as control.The basic data, pregnancy complications and other pregnancy diseases were compared between the two groups, and the risk factors and pregnancy outcomes of true umbilical cord knots were discussed, respectively.Results(1) The incidence of IVF-ET,hypertensive disorders of pregnancy(HDP),oligohydramnios, hydramnios, fetal growth restriction(FGR)and umbilical cord around the neck in the singleton group with true knot was higher than that in the singleton group without true knot, and the differences were statistically significant(all P<0.05).Multivariate Logistic regression analysis showed that oligohydramnios, hydramnios and umbilical cord around the neck were independent risk factors for true cord knot in single fetus(OR>1,all P<0.05).(2) Compared with the twin group without true knot, the incidence of monochorionic monoamnionic(MCMA)twin was higher in the twin group with true knot, and the incidence of IVF-ET and DCDA was lower(all P<0.05).Multivariate Logistic regression analysis showed that MCMA was an independent risk factor for true umbilical knot of twins(OR>1,P<0.05).(3) The ultrasound image of true umbilical cord knot showed that the umbilical cord was three-dimensionally twisted and wound into a coiled or “twisted” shape, and the direction of umbilical cord blood tube was cluttered and crossed.(4) The risk of grade Ⅲ amniotic fluid contamination increased in the singleton group with true knot(P<0.05).There was no statistical difference in pregnancy outcome between the two twin groups.Conclusion Oligohydramnios, hydramnios, umbilical cord around the neck and MCMA are the high risk factors for true umbilical cord knot in singleton and twin.The umbilical cord is three-dimensionally twisted and wound into a coiled or“twisted”shape, and the direction of the umbilical cord blood tube is cluttered and crossed, which should be highly suspected of the true umbilical cord knot.There is a higher risk of grade Ⅲ amniotic fluid contamination in the singleton group with true knot than that in the twin group and no significant difference in neonatal outcomes between the two groups.更多还原