Cord insertion into the lower third of the uterus in the first trimester is associated with placental and umbilical cord abnormalities
Cord insertion into the lower third of the uterus in the first trimester is associated with placental and umbilical cord abnormalities
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DOI：
10.1002/uog.2839
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发表时间：
2006-08-01
影响因子：
7.1
通讯作者：
Okai, T.
中科院分区：
文献类型：
--
作者：
Hasegawa, J.;Matsuoka, R.;Okai, T.
目的探讨在孕早期晚期检测脐带插入点的可行性，方法采用前瞻性队列研究方法，在孕早期应用灰阶经阴道超声检查子宫与脐带插入部位之间的位置关系，并在孕早期应用灰阶经阴道超声检查子宫与脐带插入部位之间的位置关系。怀孕11周。内口至胃底的距离平均分为三部分。位于上或中三分之一的脐带插入被定义为正常（对照），位于下三分之一的脐带插入被定义为病例，无论其与绒毛膜的关系如何。在分娩时进行妊娠晚期超声检查和胎盘和脐带病理检查，以检查胎盘/脐带异常。结果340例中，318例（93.5%）在孕9-11周时发现脐带插入部位，其中35例（11.0%）位于子宫下1/3。在这35例中，9例（26%）分娩时发现脐带插入较低，8例（23%）分娩时胎盘较低。283例脐带正常者分娩时无1例胎盘低位（P < 0.0001）。10例（29%）脐带低位插入和4例（1.4%）脐带正常插入的病例在分娩时有脐带被膜或边缘插入（P < 0.0001）。分娩时，5例（14%）低位脐带插入病例和4例（1.4%）正常脐带插入病例（P < 0.0001）存在某种形式的胎盘畸形，包括副胎盘和胎盘梗死。脐带低位和正常位置分别有4例（11%）和6例（2.1%）行急诊剖宫产术（P = 0.003）。结论脐带位于子宫下1/3者，胎盘和脐带发育异常率较高。我们认为，在妊娠9-11周时筛查脐带插入部位可能对预测分娩时脐带和胎盘异常具有临床意义。Copyright（c）2006 ISUOG.出版社：John Wiley & Sons，Ltd
Objectives To assess the feasibility of detecting the cord insertion site during the late first trimester, and to investigate the possible association between perinatal complications and a cord insertion in the lower third of the uterus in the first trimester.Methods This was a prospective cohort study in which the positional relationship between the uterus and the cord insertion site was examined using gray-scale transvaginal sonography at 9-11 weeks of gestation. The distance between the internal os and the fundus was divided equally into three parts. Cord insertions located in the upper or middle thirds were defined as normal (controls), and those located in the lower third were defined as cases, regardless of their relationship to the chorion villosum. Third-trimester sonography and pathological examination of the placenta and cord at delivery were performed to check for placental/cord abnormalities. The univariate association between the location of the cord insertion in the first trimester and placental and umbilical cord abnormalities and perinatal complications was assessed.Results The cord insertion site was identified in 318/340 (93.5%) cases at 9-11 weeks of gestation and it was in the lower third of the uterus in 35 (11.0%) cases. Of these 35, the cord insertion was found at delivery to be low in nine cases (26%) and the placenta was low-lying at delivery in eight (23%). None of the 283 cases with a normal cord insertion in the first trimester was found to have a low-lying placenta at delivery (P < 0.0001). Ten (29%) of the cases with a low cord insertion and four (1.4%) with a normal cord insertion in the first trimester had a velamentous or marginal cord insertion at delivery (P < 0.0001). At delivery, five (14%) of the low cord insertion cases and four (1.4%) of the normal cord insertion cases (P < 0.0001) bad some form of placental malformation, including accessory placenta and infarction of the placenta. An emergency Cesarean section was performed in four (11%) and six (2.1%) of the low and normal cord insertion cases, respectively (P = 0.003).Conclusion Developmental abnormalities of the placenta and umbilical cord occur frequently in cases in which the cord insertion is in the lower third of the uterus in the first trimester. We suggest that screening for the cord insertion site at 9-11 weeks of gestation may have clinical significance for predicting abnormalities of the cord and the placenta at delivery. Copyright (c) 2006 ISUOG. Published by John Wiley & Sons, Ltd.