【摘要】 目的　探讨彩色多普勒脐动脉血流仪 (CDFI)、无负荷试验 (NST)及B超检查 3种方法联合使用 ,对产前脐带缠绕的预测价值。方法　对 186 0例孕周为 37～ 42周的孕妇于产前 1～ 2周内联合应用CDFI、NST及B超进行监测 ,筛查胎儿有无脐带缠绕。结果　脐带缠绕发生率为 2 3 2 3% (4 32 /186 0 ) ,阳性预测值及阴性预测值分别为 95 4% (4 12 /4 32 )及 98 6 % (140 8/142 8) ,准确率为 97 8%(182 0 /186 0 )。脐带缠绕并不增加新生儿低评分危险 ,脐带绕身绕四肢组胎儿宫内窘迫发生率为85 2 9% (2 9/34) ;剖宫产率为 88 2 8% (30 /34) ;而脐带绕颈组胎儿宫内窘迫发生率为 13 0 6 % (5 2 /398) ,剖宫产率为 44 94% (178/398)。脐带绕身绕四肢组胎儿宫内窘迫及剖宫产率明显高于脐带绕颈组(χ2 分别为 10 7 2 7、2 3 76 ,P <0 0 0 1) ,脐带绕颈组脐动脉血流收缩期与舒张期峰值比值基本波动于正常范围。在胎心监护中 ,脐带缠绕多以变异减速波型表现 ,其次为早期减速 (ED)、NST无反应及催产素激惹试验 (OCT)出现晚期减速 (LD) ,脐带绕身绕四肢者还出现延长减速 (PD)波型。结论　联合应用CDFI、NST及B超对孕妇进行监测 ,对脐带缠绕的诊断具有重要辅助价值 ,能显著提高诊断阳性率 ,为分娩方式的选择提供有价值的参考更多还原

【Abstract】 Objective To explore the predictive value of combined application of umbilical artery color Doppler flow monitoring (CDFI), nonstress testing (NST) and ultrasonography in monitoring umbilical cord entanglement. Methods 1 860 cases of pregnant women between gestational ages of 37～ 42 weeks were studied 1～ 2 weeks before delivery by CDFI, nonstress testing (NST) and ultrasonography to monitor umbilical cord entanglement. Results The prevalence rate of umbilical cord entanglement was 23 23% (432/1 860). Positive predictive value and negative predictive value were 95 4 % (412/ 432) and 98 6% (1 408/1 428) respectively. The rate of accuracy was 97 8%(1 820/1 860). The rate of fetal distress among the fetuses with umbilical cord round the body or four limbs was 85 29% (23/34) and the incidence of cesarean section in this group was 88 28% (30/34). The rate of fetal distress among the fetuses with umbilical cord round the neck was 13 06%(52/398)and the incidence of cesarean section in this group was 44 94%(178/398) The rates of fetal distress and cesarean section were significantly higher in the group with umbilical cord around the body or four limbs than in the group with umbilical cord around the neck (χ 2=107 27 and 23 76 respectively, P <0 001). The systolic/diastolic (S/D) ratio was basically in normal ranges in the group with the umbilical cord round the neck. In cardiotopography (CTG), umbilical cord entanglement mainly showed variable deceleration (VD), early deceleration (ED), nonreaction on NST,and late deceleration (LD) on oxytocin challenge test (OCT). Prolonged fetal heart rate deceleration (PD) could be seen in the group with umbilical cord around the body or four limbs. Conclusion The combined application of umbilical artery color Doppler velocimetry, nonstress testing and ultrasonography have an important auxiliary value in monitoring umbilical cord entanglement. It remarkably increases the positive predictive rate as a valuable reference for the choice of delivery form.更多还原