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目的:探讨脐带缠绕的最佳分娩方式,以达到降低新生儿窒息及病死率的目的。方法:对2006年4月~2007年4月在本院超声检查提示脐带缠绕196例,根据新生儿出生时脐带缠绕情况分为:脐带缠绕1周148例;脐带缠绕2周23例;脐带缠绕3周及以上7例,分析3组分娩方式及新生儿情况。结果:脐带缠绕1周组临产前有指征剖宫产37例,临产后剖宫产13例,自然分娩96例,产钳助产2例,新生儿轻度窒息4例;脐带缠绕2周组临产前有指征剖宫产3例,临产前因脐带绕颈2周剖宫产13例,自然分娩7例组,新生儿轻度窒息4例;脐带绕颈3周及以上组临产前因脐带缠绕2周及以上剖宫产4例,自然分娩加腹压3例,新生儿轻度窒息3例。结论:对超声诊断脐带缠绕1周且无剖宫产指征的孕妇,入院时常规行NST或CST检查,证实无胎儿窘迫存在者,可阴道试产;对脐带缠绕2周及以上的孕妇,选择剖宫产结束妊娠为佳。
Objective: To explore the best mode of delivery of umbilical cord wound in order to reduce the neonatal asphyxia and mortality. Methods: From April 2006 to April 2007, 196 cases of umbilical cord wound were revealed in our hospital. According to the situation of umbilical cord entanglement at birth, there were 148 cases of umbilical cord wound for 1 week, 23 cases of umbilical cord wound for 2 weeks, 3 weeks and more than 7 cases, analysis of 3 groups of delivery and neonatal conditions. Results: There were 37 cases of cesarean section before labor, 13 cases of cesarean section after delivery, 96 cases of spontaneous delivery, 2 cases of forceps delivery and 4 cases of neonatal asphyxia. The umbilical cord wound for 2 weeks Prenatal indications of cesarean section in 3 cases, prenatal care for cesarean section around the neck for 2 weeks 13 cases, 7 cases of natural childbirth, mild neonatal asphyxia in 4 cases; umbilical cord around the neck for more than 3 weeks and more prepartum Umbilical cord wound around 2 weeks and 4 cases of cesarean section, natural delivery plus abdominal pressure in 3 cases, mild neonatal asphyxia in 3 cases. Conclusion: Pregnant women with umbilical cord wound for 1 week and no cesarean indications by ultrasound were routinely treated with NST or CST at admission, which confirmed that those with no fetal distress could be given a vaginal trial. For pregnant women with umbilical cord wound for 2 weeks and above, Choose cesarean section to end the pregnancy is better.