探析彩色多普勒超声诊断胎儿脐带绕颈临床价值.doc

探析彩色多普勒超声诊断胎儿脐带绕颈临床价值【摘要】目的探讨彩色多普勒超声诊断胎儿脐带绕颈临床价值。方法 对我院妇产科疑似胎儿脐带绕颈孕妇病人资料进行回顾性分析。结果超声诊断与分娩结果对照,妇产科疑似42例中,彩色多普勒超声确诊30例,临床分娩证实绕颈者31例,漏诊1例。结论彩色多普勒超声以其准确率高、直观可靠、操作简便、可重复等优点对于产前诊断胎儿脐带绕颈具有重要价值,为临床工作中选择分娩方式,保证母婴安全提供了可靠依据,值得推广应用。 【关键词】彩色多普勒超声胎儿脐带绕颈 临床价值 中国分类号:R445 文献标识号:A 文章编号:1005-0515(2010)10-040-01 【Abstract】 Objective To evaluate color Doppler ultrasound diagnosis of the clinical value of fetal cord around the neck. Methods A hospital maternity pregnant patients suspected of fetal umbilical cord around neck were retrospectively analyzed. Results results of ultrasonic diagnosis and delivery control, obstetrics and gynecology suspected 42 cases, 30 cases diagnosed by color Doppler ultrasound and clinical delivery around the neck confirmed 31 cases of missed diagnosis in 1 case. Conclusion Color Doppler ultrasound for its high accuracy, an intuitive, easy operation, the advantages can be repeated for the prenatal diagnosis of umbilical cord entanglement has important value for clinical work, mode of delivery options to ensure the safety of mother and child provides a reliable basis for should be widely applied. 【Key words】 Color Doppler ultrasound clinical value of fetal umbilical cord entanglement 脐带绕颈是导致围产儿死亡率上升的常见原因之一。产前诊断胎儿脐带绕颈具有重要的临床意义。近年来,超声诊断胎儿脐带绕颈已被临床认可。目前,临床多采用B型超声诊断胎儿脐带绕颈,然其符合率不尽相同,假阳性发生率较高。本文应用彩色多普勒对42例疑似胎儿脐带绕颈孕妇进行检查,现总结如下: 1 资料和方法 收集我院妇产科疑似胎儿脐带绕颈孕妇42例,以临产前最后一次检查结果为标准,与分娩结果进行对照。采用美国产菲利普HDI5000SonoCT彩色多普勒诊断仪,变频探头,频率为2～5MHz,取样容积2mm。孕妇采取仰卧位,平静呼吸。先在B型超声下常规检查胎儿、胎盘、脐带及羊水情况,然后换彩色多普勒,沿胎儿颈部一周检查有无脐带血流回声。以胎儿颈部背侧与颈两侧或腹侧两处以上见脐带血流回声为脐带绕颈的诊断依据。 2结果 脐带绕颈的彩色多普勒声像图特点: 2.1、胎儿颈背部有“u”或“w”形压迹,彩色血流探查时可见红或蓝色血流回声。 2.2、顺胎儿颈部环形扫查可见红和/或蓝色血流带环绕胎儿颈部。 2.3、脉冲多普勒取样容积于胎儿颈部血流处,可见动静脉血流。 超声诊断与分娩结果对照,妇产科疑似42例中,彩色多普勒超声确诊30例,临床分娩证实绕颈者31例,漏诊1例。 3 讨论 3.1 脐带缠绕为脐带常见并发症,占总分娩数的20%~25%。其中以绕颈为最多[1],其发生与脐带过长、胎动频繁等因素有关。脐带是胎儿与母体之间进行营养物质代谢的唯一通道,脐带缠绕过紧者可影响脐血通过造成宫内胎儿缺氧甚至死亡。在分娩过程中,脐带绕颈可产生脐带相对过短的后果,影响胎儿先露部的衔接和下降,使第二产程延长,同时先露部随宫缩下降时对缠绕的脐带可产生过度牵拉,也会造成脐带血流受阻,引起胎儿宫内窘迫。因此,脐带绕颈是产