Velamentous cord insertion into the lower third of the uterus is associated with intrapartum fetal heart rate abnormalities
Velamentous cord insertion into the lower third of the uterus is associated with intrapartum fetal heart rate abnormalities
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DOI：
10.1002/uog.2645
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发表时间：
2006-04-01
影响因子：
7.1
通讯作者：
Okai, T
中科院分区：
文献类型：
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作者：
Hasegawa, J;Matsuoka, R;Okai, T
目的评价超声对孕18-20周脐带附着（CL）部位的诊断准确性，比较超声对脐带附着（VCI）继发于前壁、后壁和宫底壁的检出敏感性，比较VCI继发于上壁、后壁和宫底壁的产时并发症。方法对3446例孕18-20周的孕妇进行常规超声检查，对异常CI（VCI和边缘性CI）及其在子宫内的位置进行评估。在异常CI的情况下，CI的位置进一步分类为子宫的上、中或下三分之一。结果产前检测VCI的敏感性为62.5%（25/40），阳性预测值为100%（25/25），阴性预测值为99.6%（3406/3421）。CI位于前壁的敏感性为12/13（92.3%），位于后壁的敏感性为11/22（50.0%），位于底壁的敏感性为2/5（40.0%）。使用VC时经常观察到可变减速。低VCI组胎心率异常和急诊剖宫产率高于中、高VCI组（P < 0.01）。术后病理检查VCI患者迷走血管长度上1/3为3.9 ± 3.3cm，中1/3为4.7 ± 4.6cm，下1/3为10.6 ± 6.8cm;因此，在本发明中，当CI位于子宫下三分之一时，结论低Cl位点、迷走血管较长的VCI与产时并发症的发生有关。这一发现有可能改善围产期结局。版权所有2006 ISUOG.由John Wiley & Sons有限公司出版
Objectives To evaluate the accuracy of sonographic identification of the site of umbilical cord insertion (Cl) at 18-20 weeks of gestation, to compare the sensitivities for detection of a velamentous cord insertion (VCI) secondary to a Cl into the anterior, posterior or fundal wall, and to compare the intrapartum complications secondary to VCI into the upper, middle or lower third of the uterus.Methods As part of the routine ultrasound scan at 18-20 weeks' gestation we evaluated abnormal CI (VCI and marginal CI) and the location of the Cl in the uterus in 3446 pregnancies. In cases of abnormal CI, the location of the CI was further classified as being in the upper, middle or lower third of the uterus. After delivery, the placenta and the umbilical cord were examined and intrapartum complications were compared with the location of the CI.Results The values for antenatal detection of VCI were: sensitivity, 25 of 40 (62.5%); positive predictive value, 25 of 25 (100%); and negative predictive value, 3406 of 3421 (99.6%). The sensitivity for cases in which the CI was located on the anterior wall was 12 of 13 (92.3%); when it was located on the posterior wall, the sensitivity was 11 of 22 (50.0%); and when it was fundal the sensitivity was 2 of 5 (40.0%). Variable decelerations were frequently observed with a VC]. In lower VCI cases, non-reassuring fetal heart rate patterns and emergency Cesarean sections occurred with a higher frequency than in cases with upper or middle VC] (P < 0.01). After delivery, the length of the aberrant vessels in cases of VCI by pathologic examination was 3.9 +/- 3.3 cm in the upper third, 4.7 +/- 4.6 cm in the middle third, and 10.6 +/- 6.8 cm in the lower third; thus, the aberrant vessel length was significantly greater when the Cl was in the lower third of the uterus (P = 0.024).Conclusion We have demonstrated that VCI with a lower Cl site and with longer aberrant vessels is associated with various intrapartum complications. This finding has the potential for improving perinatal outcome. Copyright 2006 ISUOG. Published by John Wiley & Sons, Ltd.