| Purpose To investigate the correlation between the impression depth of umbilical cord around neck and the blood flow indexes of the fetus middle cerebral artery and umbilical artery by ultrasonography in late pregnancy for the prediction of fetal intrauterine hypoxia, and providing a timely and effective decision-making reference for the obstetricians to choose the appropriate delivery methods for the pregnant women.Methods One hundred and thirty-nine cases of single fetus with umbilical cord around neck from37to41gestational weeks were enrolled in this study, including124cases of single round and15cases of two or more rounds of umbilical cord around neck. Pregnant women aged20to32years old, and28cases as normal control. All of the fetus had been done routine examination to exclude congenital fetus malformation and confirmed normal after delivery. In both of the control group and the umbilical cord around neck group, Color Doppler ultrasound was performed to detect the ratio of the systolic peak velocity and diastolic velocity (S/D), resistance index (RI) and pulsatility index (PI) of fetal middle cerebral artery (MCA) and umbilical artery (UA). Skin impression depth of fetal neck was measured from whom with umbilical cord around neck, and the relationship of impression depth of umbilical cord around neck, MCA and UA blood flow index were detected. At the same time tracking perinatal situation of the fetus, comparing the fetal heart monitoring results, the methods of delivery, abnormal labor rate, time of the second stage of labor, and the results were statistically analyzed.Results1.15cases of two or more rounds of umbilical cord around neck, the minimum impression depth of skin was0.72cm, while the maximum was1.18cm. average depth was0.872±0.135cm. In124cases of umbilical cord entanglement, the minimum impression depth of skin was0.35cm, while the maximum was1.38cm. In19cases, the depth was less than0.60cm, average depth was0.501±0.155cm cm; in39cases, the depth was from0.60cm to0.69cm, average depth was0.669±0.072cm; in36cases, the depth was from0.70cm to0.79cm, average depth was0.735±0.063cm; in18cases, the depth was from0.80cm to0.89cm, average depth was0.841±0.057cm; in12cases, the depth was more than 0.90cm, average depth was0.897cm. Compared with the control group respectively, the indicators of UA had no significant difference; also the comparison results between each group showed UMA indexes had no obvious difference.2.Following the increase of the depth of the case with umbilical cord around neck, S/D, RI, PI of MCA increase gradually.In the group of two or more rounds of umbilical cord around neck, S/D, RI, PI of MCA were higher than those in the control group, which had statistical significance(p<0.05). In the group with impression depth more than0.90cm group and0.80cm to0.89cm group, S/D, RI, PI of MCA were higher than those in the control group and other observation group with significant difference (P<0.01); compared with control group, MCA indexes in impression depth less than0.60cm group,0.60cm to0.69cm group and0.70cm to0.79cm group were not obviously different. There were no apparent difference of MCA indexes among the observation groups compared with each other respectively.3. Perinatal situation analysis:caesarean section was selected by all the cases of two or more rounds of umbilical cord around neck. Compared with the control group, fetus with umbilical cord around neck had increased cesarean rate, prolonged labor time in vaginal delivery during the second stage, which had statistical significance(p<0.05). The probability of abnormal birth process was slightly increased with no statistical significance. Compared with the control group, fetus with the impression depth less than0.80cm had higher probability of abnormal fetal monitoring heart rate and abnormal birth process, but the differences had no statistical significance. Fetus with impression depth deeper than0.80cm had obviously increased abnormal fetal heart rate when compared with the control group, the difference was statistically significant (p<0.05). But comparison between the two groups with umbilical cord around neck, there was no obvious difference in both of abnormal fetal heart rate and abnormal labor rate.ConclusionThis study showed in the prediction of fetal intrauterine distress, blood indexes of the middle cerebral artery was more sensitive than the umbilical artery. Situation of one loose circle around neck with skin impression depth less than0.80cm showed all hemodynamic indexes had no obvious abnormalities of fetus, pregnant women and the obstetricians did not need to have too much tension and anxiety. But when it was tight, the neck skin impression depth more than0.80cm, the ratio of S/D, PI, RI of the middle cerebral artery were significantly higher than those in control group which showed statistical difference (p<0.01), might lead to intrauterine fetal anoxia.The doctors must pay enough attention on it. At the same time, umbilical cord around neck would affect the fetus on first dew fall and cause prolonged second stage of labor, increased abnormal fetal heart rate, especially when it was tight with the skin impression depth more than0.80cm and had more circles. So when came pregnant women with fetus who had the umbilical cord around neck, the obstetricians must be careful to choose the reasonable delivery methods and pay more attention on the tight ones to reduce the incidence of bad perinatal situations. It was easy to measure the impression depth of neck skin, this method was feasible and helpful and worth clinical promotion. This method is practical and effective for indirect judgment the tightness of umbilical cord around neck, and this method is more suitable for clinical needs, It can provide a effective decision-making reference for the pregnant women with umbilical cord around neck to choose the appropriate delivery methods. |
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