Umbilical cord prolapse and perinatal outcomes
Umbilical cord prolapse and perinatal outcomes
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DOI：
10.1016/s0020-7292(03)00333-3
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发表时间：
2004-02-01
影响因子：
3.8
通讯作者：
Mazor, M
中科院分区：
文献类型：
--
作者：
Kahana, B;Sheiner, E;Mazor, M
目的：确定妊娠并发脐带脱垂的产科危险因素和围产期结局。方法：进行了一项基于人群的研究，比较所有并发脐带脱垂的分娩与没有这种并发症的分娩。使用多个逻辑回归模型进行统计分析。结果：研究中所有分娩 (n = 121 227) 中，脐带脱垂并发症占 0.4% (n = 456)。通过向后逐步多元逻辑回归模型确定的脐带脱垂的独立危险因素为：胎位不正（OR=5.1；95% CI 4.1-6.3）、羊水过多（OR=3.0；95% CI 2.3-3.9）、脐带真结（OR=3.0；95% CI 1.8-5.1）、早产（OR=2.1；95% CI 1.8-5.1）。 95% CI 1.6-2.8）、引产（OR = 2.2；95% CI 1.7-2.8）、多产（> 5 次分娩，OR = 1.9；95% CI 1.5-2.3）、缺乏产前护理（OR = 1.4；95% CI 1.02-1.8）和男性（OR = 1.3；95% CI 1.02-1.8） 1.1-1.6）。脐带脱垂后分娩的新生儿在 5 分钟时的 Apgar 评分较低，低于 7（OR= 11.9，95% CI 7.9-17.9），并且住院时间较长（平均 5.4+/-3.5 天 vs. 2.9+/-2.1 天；P < 0.001）。此外，脐带脱垂组的围产期死亡率高于对照组（OR=6.4，95% CI 4.5-9.0）。使用多元逻辑回归模型控制可能的混杂因素，如早产、羊水过多等，发现脐带脱垂是围产期死亡率的独立影响因素。结论：脐带脱垂是围生儿死亡的独立危险因素。 (C) 2003 年国际妇产科联合会。由爱思唯尔爱尔兰有限公司出版。保留所有权利。
Objectives: To determine obstetric risk factors and perinatal outcomes of pregnancies complicated by umbilical cord prolapse. Methods: A population-based study was performed comparing all deliveries complicated by cord prolapse to deliveries without this complication. Statistical analysis was performed using multiple logistic regression models. Results: Prolapse of the umbilical cord complicated 0.4% (n=456) of all deliveries included in the study (n = 121 227). Independent risk factors for cord prolapse identified by a backward, stepwise multivariate logistic regression model were: malpresentation (OR=5.1; 95% CI 4.1-6.3), hydramnios (OR=3.0; 95% CI 2.3-3.9), true knot of the umbilical cord (OR=3.0; 95% CI 1.8-5.1), preterm delivery (OR=2.1; 95% CI 1.6-2.8), induction of labor (OR = 2.2; 95% CI 1.7-2.8), grandmultiparity (> five deliveries, OR = 1.9; 95% CI 1.5-2.3), lack of prenatal care (OR = 1.4; 95% CI 1.02-1.8), and male gender (OR = 1.3; 95% CI 1.1-1.6). Newborns delivered after umbilical cord prolapse graded lower Apgar scores, less than 7, at 5 min (OR= 11.9, 95% CI 7.9-17.9), and had longer hospitalizations (mean 5.4+/-3.5 days vs. 2.9+/-2.1 days; P < 0.001). Moreover, higher rates of perinatal mortality were noted in the cord prolapse group vs. the control group (OR=6.4, 95% CI 4.5-9.0). Using a multiple logistic regression model controlling for possible confounders, such as preterm delivery, hydramnios, etc., umbilical cord prolapse was found to be an independent contributing factor to perinatal mortality. Conclusions: Prolapse of the umbilical cord is an independent risk factor for perinatal mortality. (C) 2003 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.